Precertification Specialist, Nucleus Building, Flexible Hours - Louisville
1 month ago
Accurately identifies all appropriate clinical documentation to support medical necessity for scheduled procedures medication orders multiple service lines clinics Submits authorizations clinical information timely fashion compliance plan rules utilizing CMS IP Only list Assesses orders determines patient class works physicians clarify as necessary Contacts insurance plan/payers determine eligibility coverage specific procedures benefit information Coordinates patient encounters applications registration operating systems verification systems medical applications Documents findings/communications thoroughly accurately patient record Meets exceeds productivity standards daily assignments accurate production Documents authorization information referral produce clean transaction payer Answers responds communications applications timely professional manner ensure positive patient experience Complies departmental organizational policies procedures local state federal rules regulations accrediting bodies Prioritizes work according department hospital patient needs Independently resolves questions related prior authorizations referrals insurance verification Acts liaison between patients payers providers clinical staff Responsible managing setting up peer peers appeals providers timely professional manner individual plan guidelines Works parties reschedule notify denials promptly Understands staying current payer regulations provide expected timeframes payer guidelines patients providers regarding prior authorization financial clearance Maintains compliance company policies standards conduct Complies HIPAA privacy security requirements maintain confidentiality times Performs duties assigned Education High School Diploma equivalent required Experience least one year patient access insurance verification prior authorization related experience required years prior authorization related experience preferred Medical Terminology preferred
Job description
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