Pre Cert Specialist

Pre Cert Specialist

Full-Time with Benefits Douglas, GA, US

3 days ago Requisition

Pre-Cert Specialist (FT)

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

• Responsible for submitting/obtaining any required authorization/notification for tests performed to insure proper reimbursement of claims.
• Also responsible for scheduling patients for tests.

The evaluation is to assure individual performance, departmental goals and organizational goals are aligned. It is designed to support communication between the manager and the employee. Employee perception of their own performance is very important. To maximize the benefit of this process, both the manager and the employee participate in the evaluation process.

• Reads and understands the English language.
• Ability to think critically and analytically with little or no supervision.
• Ability to work effectively in situations of high stress and conflict and communicate goals and outcomes.
• Ability to process information and prioritize.
• Possesses exceptional verbal and written communication skills.
• Possesses independent work habits, is self-reliant and self-directed.
• Ability to learn, adapt, and change as required by the job functions.
• Ability to maintain absolute confidentiality of material and information accessed and reviewed.
• Ability to move freely, reach, bend, and complete light lifting.
• Ability to use good body mechanics while performing daily job functions and ability to follow specific OSHA guidelines.
• Ability to maintain attendance to meet standard job practices.

• High School Graduate or G.E.D. required.

• None specified.

• Minimum of five years experience is required in medical or financial field.
• Certified or Registered Medical Assistant Preferred.

• Basic understanding of Medicaid, Medicare and Commercial Insurance guidelines.
• Analytical and organizational skills must be above average.
• Attention to detail, communication, and documentation skills must be excellent.
• Prior public relation experience is required.
• Operations of computer systems and business machinery also required.
• Must have the ability to communicate in a courteous manner and possess excellent telephone communication skills with the ability to remain calm in difficult situations.
• Must have the ability to talk with public in a professional manner and be able to interpret patient clinical information, charges and explain in detail.
• Must have excellent interpersonal communication skills and possess professional and neat appearance.

• Sedentary:
  Exert up to 10 lb. of force occasionally and/or a minute amount frequently - >75%

• None specified.

• None specified.

• Adolescents 13 - 18 years
• Adults 19 - 70 years
• Geriatrics - 70+ years

• Initiates contact to insurance company, including use of the internet to obtain correct patient benefit information, including deductible and co insurance amount of patient liability and certification requirements.
• Responsible for contacting insurance company or authorized representative to provide clinical information needed to obtain authorization for medical services to be provided by CRMC.
• Responsible for obtaining needed clinical information from physician office to facilitate authorization requirements, by maintaining open communication with physician offices.
• Responsible for updating schedule and contacting patient and physician office with necessary changes due to authorization requirements.
• Ensure all physician orders meet current standards and policies. Obtain clarification of orders from physician office.
• Responsible for cross training in Patient Access registration and must accurately update patient demographic and insurance information as necessary when patient contact is possible.
• Determines primary insurance liability in…