Pre-Certification II Chemo Specialist - Little Rock, United States - CARTI, Inc.

Description

JOB SUMMARY: The Pre-Certification Specialist II (Chemotherapy) provides specialized assistance to our patients and clinical staff using their knowledge base of pre-certification requirements of insurance plans as well as provide excellent patient service.

SPECIFIC JOB DUTIES AND RESPONSIBILITES:

1. Verify all demographic and insurance information on patients, including but not limited to co pays, deductibles, stop losses, guarantors, subscribers, precertification requirements, and in patient requirements. Update demographic and insurance information in a timely fashion.
2. Obtain and review Physician orders for medical necessity coverage requirements.
3. Research coverage criteria with insurance companies, medical literature, and compendiums to determine eligibility for services timely. Utilize multiple healthcare websites. Run computer generated reports for appointment schedules.
4. Communicate with all designated personnel eligibility issues in a timely fashion
5. Other duties as assigned

EDUCATION, CERTIFICATION, LICENSURE, REGISTRATION:

1. High school graduate or GED

EXPERIENCE, KNOWLEDGE, SKILLS and ABILITIES:

1. Minimum of three years' experience working in healthcare insurance or medical clinic
2. Experience in a medical clinic or other healthcare environment with high patient volumes
3. Experience working with Microsoft Office applications
4. Experience utilizing multiple systems and websites; must include strong navigational skills using the Intranet as well as utilization of Internet sites
5. Experience working with managed care, medical terminology, pre-cert processes, and insurance claims processing
6. Working knowledge and familiarity of coding (such as ICD9, ICD10, CPT, and HCPCS) in order to effortlessly process chemo pre-certification requests
7. Ability to handle high patient volumes daily
8. Excellent problem solving skills and be extremely detail oriented
9. Ability to demonstrate knowledge and experience with clinical coverage guidelines and medical policies.

REASONING ABILITY:

1. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
2. Ability to interpret a variety of instructions furnished in written, oral, or schedule form.

INTERPERSONAL SKILLS:

1. Must interact and communicate both verbally and in written form.
2. Must interact and exchange information regarding patients with physicians and other departmental personnel, and outside agencies on a frequent basis while respecting the confidentiality of patient information.

PHYSICAL DEMANDS:

1. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
2. While performing the duties of this job, the employee is regularly required to talk or hear.
3. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
4. Specific vision abilities required by this job include close vision and the ability to adjust focus.

WORK ENVIRONMENT:

The work environment described here are representative of those an employee encounters while performing the essential functions of this job. This position involves potential exposure to infectious diseases. Colleagues are offered appropriate vaccinations and safety training.

COMMENTS:

This description is intended to describe the essential job functions, the general supplemental functions and the essential requirements for the performance of the job. It is not an exhaustive list of all duties, responsibilities and requirements of a person so classified. Other functions may be assigned and management retains the right to add or change the duties at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.