Precertification Specialist - Strong Hearts Clinic (FTD)

This position is responsible for obtaining and completing all insurance precertifications and authorizations as required for various clinical procedures. Determines necessity for precertification and coordinates with insurance companies, patients and clinical staff to obtain information. Maintains complete and accurate documentation in patient charts. Develops and maintains effective relations with insurance companies, physicians and medical office staff. Must have proficient knowledge of insurance requirements, medical/clinical terminology, medical necessity associated with various clinical procedure codes and certification/referral work flow. This position requires the ability to work with minimal supervision.

Work Schedule

Monday - Friday, or as directed by department supervisor.

Primary Duties

1. Obtain and complete all insurance precertification and authorizations as required for various clinical procedures.
2. Determine the necessity for precertification and coordinate with insurance companies and clinical staff to obtain information necessary to obtain precertification and authorization.
3. Maintain complete and accurate documentation within the patient medical record.
4. Maintain proficient knowledge of insurance requirements, medical/clinical terminology, and medical necessity associated with various clinical procedures.
5. Utilize clinical documentation to obtain the appropriate CPT procedure codes for various clinical procedures from coding staff as necessary.
6. Exercise effective time management and prioritization skills to effectively complete urgent precertification/authorization requests.
7. Maintain proficient knowledge of certification/referral work flow.
8. Develop and maintain effective relationships with physicians, medical office staff, and insurance companies.

• Education: High school diploma or equivalent required. Associate of Science preferred.
• Licensure/Certification: None required. Current medical assistant certification or state licensure as a Practical Nurse (or licensure from a state within the Nursing Compact) preferred.
• Experience: Minimum of three years experience in medical registration/admissions, precertification and/or medical insurance required.

This position is designated as a safety sensitive position because of the essential duties of the job involves critical medical care to patients.  A lapse in attention to detail may constitute a threat to health or safety resulting in injury, illness or death.  This position is required to work in a constant state of alertness in a safe manner.