Precertification Specialist

Precertification Specialist

Clearview Cancer Institute is north Alabama's leading cancer treatment facility. For over 30 years Clearview Cancer Institute has provided leading-edge treatment and compassionate care to those diagnosed with cancer or blood disorders. Clearview offers every service and amenity needed in an outpatient setting and our dedication to research and involvement in Phase I-IV clinical trials gives our patients the opportunity to receive potentially life-saving treatment options.

Job Purpose

The purpose of the Precertification Specialist is to ensure the effective and efficient use of services, monitor appropriateness and medical necessity, and provide necessary information for authorization.

Essential Job Functions

• Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner.
• Responsible for obtaining complete and accurate insurance information and benefit verification.
• Check all insurance information to be sure the information we have is correct and make changes if necessary.
• Contact insurance companies to obtain precerts when necessary for procedures.
• Maintain files for all authorizations and denials.
• Meet with patients as necessary to fill out financial forms, make payments, and/or set up on payment plan.
• Update new patient information and edit any established patient demographics.
• Answer phones when needed.
• Contact insurance companies to obtain precertification for imaging studies when necessary.
• Communicate with imaging and physician schedulers, imaging technologists, and RN's for proper imaging procedures.
• Ability to be at work regularly and on time.
• Other duties as assigned.

Qualifications

• Must have knowledge of insurance companies and their policies.
• Must be organized and efficient.
• Must be able to prioritize and complete tasks in a timely manner.
• Must be able to follow directions.
• Must have knowledge of ICD-10 coding and CPT coding.
• Must have knowledge of medical terminology.
• Must have knowledge of Microsoft programs.
• Must have ability to communicate with physicians for peer-to-peer consults.
• Knowledge of medical facility scheduling.
• Must have ability to communicate in a professional manner through email, over the phone, and face to face.

Education/Experience

• Must have a high school diploma or equivalent.
• Must have at least (1) year experience in a medical office setting.

Working Conditions

This position works in the imaging department of a busy oncology/hematology clinic. This person generally only has contact with patients via phone.

Physical Requirements

This position requires that the employee be able to sit at a desk in front of a computer for up to eight hours a day. Some walking and standing may be required to complete tasks.

Direct Reports

This position is not a supervisory position.