Pre Certification Specialist - Gus-Toledo - Full Time

POSITION SUMMARY

Performs prior authorization/certification of scheduled services with payers. Provides clinical review and document submission of pre-certification requests for scheduled elective services.

ACCOUNTABILITIES

• Performs clinical review and document submission to obtain pre-certification/authorization requests for orthopedic surgeries and injections.
• Completes consistent review of individual payer policies to identify changes affecting pre-certification authorizations. Maintains current working knowledge on medical criteria relating to prior authorization requirements by third party payers and medical necessity requirements.
• Participate in process development and improvement as it relates to obtaining authorizations, communication, education, etc.
• General understanding of coding for surgeries and injections to be able to communicate and document medical necessities for procedures.
• Thoroughly documents actions and resolutions taken in appropriate information system(s).
• Additional responsibilities/duties will be assigned based on teamwork load and competency

Education: Associate degree or 5 years of Billing/Insurance Verification experience.

Skills: Familiarity with ICD10 and CPT codes applicable to services rendered.

• Demonstrated ability to communicate with medical and administrative staff and patients, understanding levels of care.
• Have strong organizations skills and the ability to multi-task with phone calls, messages, and website certifications.
• Ability to understand directions and be able to communicate and respond to inquiries; requires effective interpersonal and telephone/electronic messaging etiquette skills.
• Proficient computer skills and knowledge of general office applications.
• Demonstrate the ability to accurately and independently solve problems.
• Ability to manage large volumes of work, ability to quickly learn and retain information regarding issues that present themselves.

Years of Experience: 5 years of relatable or equivalent experience in medical office

ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace