Pre-Certification Specialist

Job Description

POSITION SUMMARY:

The Pre-Certification Specialist is responsible for verifying funding for each patient that enters Central Intake and transferring or completing precertification within a timely fashion. Maintains accurate documentation to reflect all contacts made. Reports to and functions under the direction, instruction, and supervision of the Provider Services & Baker Act Office Supervisor.

QUALIFICATIONS:

Associate’s degree from an accredited college plus five years experience in a related field, or Bachelor’s degree from an accredited college or university, plus three years experience in a related field, or master’s degree from an accredited college or university, plus one year experience in a related field. Needs to be able to read and write proficiently, needs to be able to utilize Microsoft Word, Excel, Outlook, PowerPoint & Avatar.

FUNCTIONAL RESPONSIBILITIES INCLUDE:

Verification of Fund Source for each new patient in Central Intake. Completes a transfer or precertification as indicated by the fund source. Maintains good documentation on all forms to reflect contacts made for authorization. Relays all duties completed and those that need to follow up on email shift report for the following shift. Follow up on all incomplete tasks from the prior shift. Maintains good communication with other managed care staff, as well as Central Intake and CSU regarding funding & authorization issues. Responds to emails regarding changes or updates in funding as soon as they are known, but no later than the end of each shift.

COMPLIANCE RESPONSIBILITIES INCLUDE:

Adheres to all applicable federal, state, local, and company-maintained standards of compliance, ethics, and policies concerned with the administration and delivery of agency services. Meets deadlines, requirements, and expectations as established by the supervisor, agency, and department. Completes administrative functions and data entry timely and accurate.

CUSTOMER SERVICE RESPONSIBILITIES INCLUDE:

Provides exceptional customer service in all communications and interactions with staff and, the general public. Maintains confidentiality and remains calm under stress. Assists staff with support in all areas of functional responsibility in a courteous, supportive manner. Maintains and exhibits servant leadership qualities and exceeds customers’ expectations.

PHYSICAL DEMANDS:

Abilities in reaching, bending, talking, sitting, carrying, standing, grasping, fine hand coordination, ability to read and write, and the ability to remain calm under stress. Ability to reach with hands and arms, climb stairs, balance, stoop, kneel, crouch, or crawl. Must be capable of lifting 20 pounds alone.

WORK ENVIRONMENT:

General office, health care setting with client contact. Most work is completed while seated at the desk using standard office equipment. Fast-paced team approach. Multi-tasking ability requires above-average time management skills. EOE

DRUG-FREE WORKPLACE

Shift Varies, PRN (As Needed) #J-18808-Ljbffr 6AM City, LLC