Precertification Specialist

Precertification Specialist# Precertification Specialist SUN Behavioral Houston - Houston, TX 77054## Overview Position Type Part Time Job Shift Days Education  Level High School/GEDTravel Percentage None Category Health  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