Precertification Specialist II

Surgery Precertification Specialist

Job description

I. General Summary

Pre-Cert Specialist obtains surgery pre-authorizations, processes patient payments, provides excellent customer service to all guests, patients, adjusters, and clients.

II. Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Obtain surgery authorization for procedure requested by the physician in an effective and efficient manner.

2. Analyze patient insurance plans to determine financial responsibility; verifying insurance benefits and eligibility.

3. Collect surgery deposits from patient in a timely manner. Must keep cash, checks and credit cards secure and confidential.

4. Demonstrates positive and helpful assistance to patients, adjusters and office staff to include answering various questions.

5. Receives and screens visitors and telephone calls. Provides basic information in person and on the telephone.

6. Other duties and projects as assigned.

III. Education and Experience

1. High School Diploma or equivalent (GED) is required.

2. Relevant front-desk and customer related experience required.

3. 1 to 3 years' experience within a healthcare environment or relevant equivalent required.

4. Prior experience in customer service, knowledge of different insurance plans and the ability to research complex issues required.

IV. Knowledge, Skills and Abilities

1. Ability to interact with personnel of all levels within the organization and work within a fast paced team environment.

2. Ability to maintain a culture of excellent customer service, open and friendly staff relations and approachable demeanor with all levels of staff.

3. Interpersonal skills, customer orientation and an outgoing and pleasant demeanor.

4. Prior experience and demonstrated competence with patient or customer information systems required.

5. Excellent verbal, written and interpersonal communication skills to communicate effectively with all levels hospital staff, patients, visitors, and levels of staff; along with organizational and analytical skills required.

6. Advanced reading, data entry and computer skills.

7. Knowledge of HIPAA regulations and maintain confidentiality of patient and client information.