Pre-Cert Specialist

Job Description

Job Description

Overview

Responsible for acquiring managed care authorizations for assigned facilities following the managed care companies’ requirements. Pre-Cert Specialist is responsible for obtaining the appropriate reimbursement based on the negotiated Signature Healthcare contracts and securing any appropriate reimbursement for excluded items.

Responsibilities

• Meet the physical and sensory requirements stated below and be able to work in the described environment.
• Working closely with Signature Intake Solutions to initiate and obtain managed care authorizations promptly via process used by Signature Healthcare.
• If a preferred vendor is required by the health plan for ancillary needs ( x-ray, pharmacy, ambulance, DME, etc) communicate that using Signature Healthcare Process.
• Documents authorizations, exclusions and other key information to the team using defined processes.
• Works as the liaison between the insurance pre-cert department and Signature to assure appropriate process are followed.
• Responsible for collaborating with other members of the managed care team as required to assure successful managed care outcomes.
• Ensures compliance with federal and state regulations as well as the Signature HealthCARE companies policies and procedures.
• Cooperatively works with the Sales and Marketing team.
• Conducts job responsibilities in accordance with the standards set by the Code of Conduct, Policies and procedures, applicable federal and state laws, and applicable professional standards.

Qualifications

• Registered Nurse or Licensed Practical/Vocational Nurse with current state license, preferred.
• Three (3) years’ experience in a Long-Term Care environment preferred working directly with Managed Care Services.
• Experience with the Case Management Process.
• Effective verbal and written English communication skills.
• Demonstrated advanced skills in Microsoft Word, Excel, Power Point and Outlook, Internet and Intranet navigation, and Adobe.
• Highest level of professionalism with the ability to maintain confidentiality.
• Customer service oriented with the ability to work well under pressure.
• Strong attention to detail and accuracy, excellent organizational skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity.
• Strong analytical and problem-solving skills.
• Ability to work with minimal supervision, take initiative and make independent decisions.
• Ability to deal with new tasks without the benefit of written procedures.
• Approachable, flexible and adaptable to change.
• Function independently, and have flexibility, personal integrity, and the ability to work effectively with stakeholders and vendors.