- 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
- 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.
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Pre-Certification Specialist
4 weeks ago
ProMedica Health System Toledo, United States Full timePOSITION 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 t ...
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Cascade Solutions Northwood, United StatesVolg is the specialist for village shops and small areas in German- and French-speaking Switzerland. We value customer proximity - as a nearby shopping opportunity as well as in personal contact. Our employees are the heart of the store and we place great importance on individual ...
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Radiant Technologies Rossford, United StatesAre you looking for a meaningful and future-oriented apprenticeship in a social profession? It is important to you to receive a decent salary from the beginning, to take on responsibility, and to be welcomed as part of a dedicated team? Then you've come to the right place. · Your ...
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Cardiac Cath Lab
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Trusted Health Toledo, United StatesTrusted is seeking an experienced allied health professional for this exciting travel assignment. Trusted has streamlined the travel experience by enabling clinicians to apply directly to jobs without the need for recruiters. This unique approach provides more transparency, elimi ...
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ProMedica Toledo, United States Full timeJob Description: · ProMedica Toledo Hospital is one of the largest acute-care facilities in the region. Our 794-bed hospital is staffed by more than 4,800 professional healthcare employees who serve a 27-county area throughout northwest Ohio and southeast Michigan. We also have t ...
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ProMedica Toledo, United States Full timeJob Description: · ProMedica Toledo Hospital is one of the largest acute-care facilities in the region. Our 794-bed hospital is staffed by more than 4,800 professional healthcare employees who serve a 27-county area throughout northwest Ohio and southeast Michigan. We also have t ...
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ProMedica Toledo, United States Part timeJob Description: · ProMedica Toledo Hospital is one of the largest acute-care facilities in the region. Our 794-bed hospital is staffed by more than 4,800 professional healthcare employees who serve a 27-county area throughout northwest Ohio and southeast Michigan. We also have t ...
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Ophthalmologist - Neuro
3 weeks ago
ProMedica Toledo, United States Full timeProMedica Physicians Vision Associates is looking for a fellowship trained Neuro-Ophthalmologist. · ProMedica is seeking a neuro-ophthalmologist to provide care at our multi-specialty eye care practice in Toledo, Ohio. The current retiring doctor is an ophthalmologist and perfor ...
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ProMedica Toledo, United States Full timeJob Description: · ProMedica Toledo Hospital is one of the largest acute-care facilities in the region. Our 794-bed hospital is staffed by more than 4,800 professional healthcare employees who serve a 27-county area throughout northwest Ohio and southeast Michigan. We also have t ...
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Certified Anesthesiologist Assistant
2 weeks ago
University of Toledo Physicians Perrysburg, United StatesUniversity of Toledo Physicians' mission is to improve the human condition through excellence in patient care and medical discovery. Representing more than 200 physicians, UT Physicians are leaders in clinical care, research and education of the future physicians, providing care ...
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Certified Anesthesiologist Assistant
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University of Toledo Physicians Toledo, United StatesUniversity of Toledo Physicians' mission is to improve the human condition through excellence in patient care and medical discovery. Representing more than 200 physicians, UT Physicians are leaders in clinical care, research and education of the future physicians, providing care ...
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Travel Nurse
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Lead Health Toledo, United StatesLead Health is seeking an experienced Progressive Care Unit Registered Nurse for an exciting Travel Nursing job in Toledo, OH. Shift: 3x12 hr nights Start Date: 06/25/2024 Duration: 13 weeks Pay: $ / Week Join the Traveler Tribe today · We are looking for a RN - Progressive Care ...
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Nursing Practice Specialist
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ProMedica Toledo, United StatesProMedica is a locally owned, nonprofit healthcare organization serving northwest Ohio and southeast Michigan. Driven by our Mission to improve your health and well-being, we offer a full range of diagnostic, medical and surgical specialties in areas such as emergency medicine an ...
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medical assistant/adult neurology
2 weeks ago
The Toledo Clinic Toledo, United States Full time Hourly 30-40Toledo Clinic's Adult Neurology Department is seeking a full-time Medical Assistant to provide both clinical and administrative support in a busy office. Qualified candidates will have an MA credential (RMA/CMA/CCMA) or able to obtain such credential within 60 days of employment. ...
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Travel Nurse
1 week ago
KPG Healthcare Nursing Toledo, United StatesKPG Healthcare Nursing is seeking an experienced Progressive Care Unit Registered Nurse for an exciting Travel Nursing job in Toledo, OH. Shift: 3x12 hr nights Start Date: ASAP Duration: 13 weeks Pay: $2081 / Week Travel PCU Registered Nurse (RN) - $2,081 per week in taxable pay ...
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Travel Nurse
1 week ago
KPG Healthcare Nursing Toledo, United StatesKPG Healthcare Nursing is seeking an experienced Progressive Care Unit Registered Nurse for an exciting Travel Nursing job in Toledo, OH. Shift: 3x12 hr days Start Date: ASAP Duration: 13 weeks Pay: $2032 / Week Travel PCU Registered Nurse (RN) - $2,032 per week in taxable pay a ...
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Lower School Teaching Assistant
3 days ago
Maumee Valley Country Day School Toledo, United States Full timeBenefits:Dental insurance · Health insurance · Position Opening: Lower School Teaching Assistant (Kindergarten through Third Grade) · Type: Full-time faculty · Application deadline: Open until filled · Start date: August 6, 2024, for orientation · Maumee Valley Country Day Sch ...
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Maumee Valley Country Day School Toledo, United States Full timePosition Opening: Upper Elementary Classroom Teacher with Math and Science Specialties · Type: Full-time faculty (185 days paid over 12 months) · Application Deadline: Open until filled · Start Date: Aug. 6, 2024, for orientation · Maumee Valley Country Day School is seeking a ...
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Phlebotomist I
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Innova Solutions Toledo, United States ContractInnova Solutions is immediately hiring a Float Phlebotomist. Position Type: Full Time, Contract to possible hire · Duration: 3 months · Location: Toledo Ohio Mile radius of float) · Shift/Schedule: 1st shift. Mon – Fri 8am – 5:30pm As a Phlebotomist, your responsibilities: · Ex ...
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Zoning Compliance Specialist
2 days ago
City of Toledo Toledo, United States Full timeZoning Compliance Specialist · Salary $63, $67,327.52 Annually · Location Toledo, OH · Job Type Full-Time · Job Number · Department Plan Commission · Division Planning Commission · Opening Date 06/06/2024 · Closing Date 7/18/2024 11:59 PM Eastern · Description · POSITI ...
Pre-Certification Specialist - Toledo, United States - ProMedica
Description
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
Education:
Associate degree or 5 years of Billing/Insurance Verification experience.
Skills:
Familiarity with ICD10 and CPT codes applicable to services rendered.
ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit
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.
Equal Opportunity Employer/Drug-Free Workplace
Employee Exemption Type
Non-Exempt
Job Type
Full Time
Budgeted Hours / Pay Period
80
Shift Type
Days
Shift Hours
8 hours
Weekends
On-call Requirements
Additional Schedule Details
Pre-Certification Specialist professionals in Toledo
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Mazen Massa
Data Network (Data Centet/ISP) engineer