Pre-Certification Specialist

Qualifications
High School Diploma or GED (Required)

Work Experience
2 years experience in a health-related environment (hospital or Physician's office) (Required)

Licenses and Certifications
Required Certifications/Licensures:
Certified Healthcare Access Associate (CHAA) within 15 months of hire; previous Certified Patient Account Representative (CPAR) certification acceptable

Essential Functions
DOCUMENTATION:
Documents and submits required information and data in a timely fashion.
Ensures that documentation is tailored to expected readers/users.
Ensure correct plan code has been entered in Meditech
Uses correct terminology.
Conforms to required style and format.

AUTHORIZATION:
Ability to obtain necessary information from insurance companies and completion of correct forms necessary to complete the pre-cert/authorization process.
Ensures pre-cert has been completed.
Knowledge of pre-cert requirements/all payers.

UTILIZATION OF MEDITECH/ATHENA/MOSAIQ:
Ability to understand and utilize systems for medical information look up and documentation.
Log in procedures.
Printing reports.
Quality checklist procedures.
Status procedures.

KNOWLEDGE OF THIRD-PARTY PAYERS:
Ability to understand and follow the policies and practices of insurance companies as it related to pre-cert/authorization.
Determining Eligibility.
Verification of coverage.

Additional Duties
Adheres to the hospital and departmental attendance and punctuality guidelines.
Performs all job responsibilities in alignment with the core values, mission and vision of the organization.
Performs other duties as required and completes all job functions as per departmental policies and procedures.
Maintains current knowledge in present areas of responsibility (i.e., self education, attends ongoing educational programs).
Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs.

For non-clinical areas, has attended training and demonstrates usage of age- specific customer service skills.
Wears protective clothing and equipment as appropriate.