Precertification Specialist

Precertification Specialist# Precertification SpecialistSUN Behavioral Houston - Houston, TX 77054## OverviewPosition TypePart TimeJob ShiftDaysEducation LevelHigh School/GEDTravel PercentageNoneCategoryHealth Care## Description**Position Summary:**Responsible for obtaining pre-certifications and pre-authorizations for hospital service lines per assigned caseload by successfully completing the required authorization process in addition to effectively communicating details to appropriate departments.**Position Responsibilities:***Clinical / Technical Skills* (40% of performance review)* Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations.* Request, track and obtain pre-authorization from insurance carriers within time allotted for assigned workload and follow up on regularly pending cases.* Ensure tracking programs and patient records are kept up to date through the pre-certification process.* Demonstrate and apply knowledge of medical terminology, high proficiency of general inpatient hospital understanding including HIPAA regulations.* Clearly document all communication and contacts with providers and personnel in standardized documentation requirements.* Communicate any insurance changes or trends among team.* Prioritize authorization requests according to urgency.* Answer insurance telephone inquiries pertaining to patient accounts.* Perform other duties as required.*Safety* (15% of performance review)* Strives to create a safe, healing environment for patients and family members* Follows all safety rules while on the job.* Reports “near misses”, as well as errors and accidents promptly.* Corrects minor safety hazards.* Communicates with peers and management regarding any hazards identified in the workplace.* Attends all required safety programs and understands responsibilities related to general, department, and job specific safety.* Participates in quality projects, as assigned, and supports quality initiatives.* Supports and maintains a culture of safety and quality.*Teamwork* (15% of performance review)* Works well with others in a spirit of teamwork and cooperation.* Responds willingly to colleagues and serves as an active part of the hospital team.* Builds collaborative relationships with patients, families, staff, and physicians.* The ability to retrieve, communicate, and present data and information both verbally and in writing as required* Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word.* Demonstrates adequate skills in all forms of communication.* Adheres to the Standards of Behavior*Integrity* (15% of performance review)* Strives to always do the right thing for the patient, coworkers, and the hospital* Adheres to established standards, policies, procedures, protocols, and laws.* Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence.* Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources.* Completes required trainings within defined time periods, as established by job description, policies, or hospital leadership* Exemplifies professionalism through good attendance and positive attitude, at all times.* Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws.* Ensures proper documentation in all position activities, following federal and state guidelines.*Compassion* (15% of performance review)* Demonstrates accountability for ensuring the highest quality patient care for patients.* Willingness to be accepting of those in need, and to extend a helping hand* Desire to go above and beyond for others* Understanding and accepting of cultural diversity and differences## Qualifications**Education*** Required: High school diploma or GED. CPR and hospital-selected de-escalation technique certification.* Preferred: Associates or Bachelors degree.* Maintains education and development appropriate for position.* May substitute experience for education**Experience*** Required: One year of experience in a behavioral healthcare setting.* Preferred: Previous experience as Precertification Specialist* May substitute education for experience #J-18808-Ljbffr