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Pre-Certification Specialist - Bethlehem, United States - St. Luke's Hospital
Description
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St.Luke's are our most valuable asset Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.
The Pre-Certification Specialist is responsible for contacting health insurance companies prior to procedures, testing or admission to the hospital to verify coverage either online or by telephone.
The precertification specialist is also responsible for relaying precertification information to performing facility and for facilitating appeals if initial approval denied.
JOB DUTIES AND RESPONSIBILITIES:
Receives instructions from the physician regarding what procedure or testing is needed
Obtains precertification/pre-authorization from insurance companies prior to procedure or testing utilizing an online application or contacting the insurance company by telephone
Verifies and completes patient eligibility, coverage verification, and benefit investigation for the procedure using an online application or by telephone.
Maintains online log of patient's requiring precertification
Maintains working knowledge of Navinet (online precertification application)
Responds to written and telephone inquiries from patients, insurance carriers and facilities regarding planned services
Maintains detailed knowledge of computer software systems as it relates to job functions
Analyzes current procedures, bringing suggestions for improvement to the attention of team members and team lead/supervisor/manager/director consideration
Document authorizations in medical record and provide to appropriate sources
PHYSICAL AND SENSORY REQUIREMENTS:
Sitting up to eight hours a day. Continually use fingers for typing and writing. Routinely use upper extremities. Stoop, bend and reach above shoulder level regularly. Vision must be correctable to 20/20 and hearing must be in the normal range for telephone calls. Position also requires viewing computer screens and typing for long periods of time.
EDUCATION:
High School diploma required.
TRAINING AND EXPERIENCE:
Previous precertification experience helpful. Medical coding and terminology experience preferred.
Please complete your application using your full legal name andcurrent home address. Be sure toincludeemployment history forthe past seven (7) years, including your present employer. Additionally, you areencouraged to upload a current resume, including all work history, education, and/or certifications andlicenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's
St. Luke's University Health Network is an Equal Opportunity Employer.