Insurance Pre-Cert Coord

Penn Medicine Pre-Certification Specialist

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Summary:

• Obtain pre-certification and referrals for inpatient and same day encounters. Verification of benefits and pre-certify selected outpatient registrations. Provide specialized support in the areas of insurance and billing information. Support the representatives solving problems and answering questions. This position will ensure access to integrated health care; achieve clinically appropriate authorization to assure optimal reimbursement for the hospital for services provided.

Responsibilities:

• Review chemo schedule in advance and determines patients insurance requirements for pre-cert, patient payments, coverage limitation and determine necessary action prior to patient arrival. Assess information for appropriateness of setting and utilization of resources to optimize patient outcomes and cost effectiveness. Maintain communication with provide education to all involved departments included but not limited to admissions, business office, case managers and medical staff and designees. Provide required clinical and demographic information to payer to obtain precertification and assure reimbursement. Communicate with patients to verify incomplete insurance information and remind the HMO patients to obtain a referral and make patient aware of any co-pays. Pre-certify and obtain authorization numbers and enter into Epic insurance flowsheet. Obtaining medical, ICD-9 and CPT codes. Interact with medical staff and their designees to obtain complete, accurate, timely clinical and financial information required for payer reimbursement. Fax all information required to insurance companies to ascertain an authorization number for pre-cert. Keeping within the standards set by the Office of Compliance and HIPPA in reference to confidentiality. Assist admissions representative obtaining pre-cert and authorization numbers. Keep representatives apprised of any changes in the process. New and improved methods of obtaining insurance authorizations Internet, envoy. Follow up with all review companies on all pending authorizations and referrals. Checks-in/arrives patient appointments daily in Epic. Pre-register appointments 24 hours in advance of patient's appointment. Maintain excellent working relationships with all insurance companies. Communication and maintain excellent working relationships with referring physicians and their staff. Work approximately one week in advance whenever possible. Provide accurate information to billing and case management to assure payment of claims. Willingly accepts responsibility and demonstrates positive and competent performance. Provides ongoing education and exhibits a willingness to share current knowledge with team members as necessary to help meet organizational goals. Maintain current knowledge about pre-certification process for all Federal, State, and 3rd party payors. Identifies systems issues impacting on the use of resources. Observance of or Patient Access Hospitality House Rules. Courtesy and politeness. Friendliness. Concern for each patient's well being. Sensitivity and prompt responsiveness to the patient's wants and needs. Cooperation with and helpfulness to the patient, members of the patient's family, visitors and co-workers. Pride in self, professions and the hospital. Respect for other people. Key Team partners include: Patient Accounting Team including Financial Counseling, Registration, Nursing Management, SPU staff, Physician Office staff, CBO management. Shares resources and information across boundaries to ensure customer needs are met and status of the revenue cycle is maximized. Supports proactive communication to enable high performance of all individuals. Ability to assess, prioritize and complete multiple tasks in a stressful environment. Judgement capability to differentiate between decisions which can be made independently and those that should be referred to management. Problem solving - take initiative to correct problematic situations. Communicates appropriately and effectively with supervisors, nurse managers, peers, patients/customers and outside agencies. Follow professional and proper telephone etiquette using interpersonal skills and required job knowledge (List). Effective management skills including but not limited to communication, conflict resolution, problem solving, work redesign and policy and procedure documentation. Working knowledge of hospital billing and reimbursement issues as they relate to information required at time of outpatient care. Epic Schedgistration Training (can be completed after hire). Proactively shares information and trends. Treats colleagues and staff with dignity and respect. Ensures absolute confidentiality. Creates a work environment that attracts and remains key talent. Facilitates the identification of common goals. Identifies opportunity for improvement. Prioritizes own work with minimal involvement of supervision. Takes personal responsibility for Department performance.

Credentials:

Education or Equivalent Experience:

• H.S. Diploma/GED (Required)
• Or equivalent required Education Specialization:
• Other (Required)
• And 3+ years Minimum of 3 years experience in a healthcare environment or education in lieu of experience (Associate's or Bachelor's degree) Education Specialization:

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.