Pre Certification Clerk

Day In The Life Of a Pre-Certification Clerk

The Pre-Certification Clerk is responsible for obtaining all prior authorizations and referrals as required per insurance guidelines. This position is responsible for communication with patients, appropriate clinical departments, and/or insurance providers regarding insurance approval/denial. The Pre-Certification Clerk will also coordinate Peer-to-Peer reviews and communicate with Physicians, offices, and departments all necessary information needed to complete the authorization for services. Acts as an authority on admission criteria and insurance expectations.

This position is required to work closely with clinical and billing departments, utilizing their knowledge of both areas.

• 403(b) with 4% employer match
• ANCC Magnet Hospital
• 21 PTO days per year (increases with tenure)
• Education Assistance Program
• Employee Sponsored Wellness Program
• Employee Assistance Program
• Loan Forgiveness Eligible

• Reviews all prescheduled diagnostic procedures, outpatient therapies, infusions, and surgeries daily.
• Reviews all diagnostic and surgery registrations for accuracy; identify and reconcile all errors.
• Verifies all diagnostic, procedural and surgical eligibility, and admissions, including eligibility & benefits on all worker’s compensation, and high-risk outpatients (e.g., motor vehicle or third-party liability).
• Obtains and documents precertification, certification, and/or proper referral during the verification process to include ABN’s and financial letters. Completes all necessary forms and paperwork prior to patients being seen for services.
• Creates, if necessary, any pre-scheduled registrations that have not been completed prior to date of service, and route them to appropriate location.
• Re-checks all inpatients for accuracy.
• Runs estimates, prior to visit and notify patient of financial responsibility.
• Collects appropriate monies due or directs patient to pre-arrange for payment plans with each patient. Reviews and discusses all patient financial responsibility at the appropriate time in the admission process.
• Contacts MD office when authorization/referrals are pending to evaluate how to proceed as needed; contacts patient after resolution with MD office.
• Double checks social data for any errors, patient data, guarantor data, and reconcile if necessary, to avoid problems on bill, communicate changes to appropriate departments.
• Processes and evaluates physician orders for accurate patient information, physician signature, appropriate diagnosis, and procedure codes. Utilizes appropriate coding guideline to accurately assign CPT, ICD 9, ICD 10 and HCPCS codes to outpatient procedures.
• Maintains a high level of customer service/satisfaction; this is accomplished by timely and accurate completion of all duties as outlined above and meeting pre-defined metrics.

• Excellent verbal, written and interpersonal communication skills
• Strong knowledge of the admission process
• Knowledge of both government and a non-government payer
• Ability to demonstrate a basic understanding of hospital insurance contracts to determine if treatment and services are covered by insurance at facility
• Ability to demonstrate an independent work initiative with sound judgment and attention to detail
• Ability to handle multiple tasks simultaneously
• Ability to operate standard office equipment
• Knowledge of medical terminology

• High school diploma (or Equivalent Certificate from an accredited program) or higher degree
• Two (2) or more years of healthcare registration, billing, or clinical experience

Cheyenne Regional Medical Center was founded in 1867 as a tent hospital by the Union Pacific Railroad to treat workers injured while building the transcontinental railroad. Today, we are the largest hospital in the state of Wyoming, employing over 2,000 people, and treating over 350,000+ patients from southeastern Wyoming, western Nebraska, and northern Colorado. We pride ourselves on patient and employee experience by living our core values of Integrity, Caring, Compassion, Respect, Service, Teamwork and Excellence to I.N.S.P.I.R.E. great health.

Our team makes a difference every day by providing trusted healthcare expertise through a passionate and I.N.S.P.I.R.E.(ing) approach with a personal touch. By living our values, we aim to achieve our goal of becoming a 5-star rated hospital, providing critical support and resources to our community and the greater region we serve. If you are eager to make a difference and passionate about healthcare, we encourage you to apply today!