Pre Certification Specialist

Major Responsibilities:

• To perform all activities related to third-party payer pre-certification requirements to meet the daily pre-certification functions at Dreyer Medical Clinic.
• Completes pre-certification process or transfers call as appropriate.
• Upon completion of the pre-certification process, enters authorization number in the order and closes encounter.
• Monitors all Peer-to-Peer pre-certification decisions forwarded by RN Nurse Specialist and closes case with appropriate determination from pre-certifcation vendor.
• Verifies per insurance type and service requested the need for pre-certification. Notifies the Business Office when patients with No Insurance or Termed Insurance are identified.
• Reviews pended order for completeness and accurate coding.
• Contacts the pre-certification vendor and provides the facility and patient demographic information.
• Monitor future orders and assure completion of pre-certification process by due date of procedure.
• Identifies orders placed outside the number of days determined valid by the pre-certification vendor and postpones those orders in EPIC using postpone function or staff message function.
• Serves as an advocate and liaison between patients, associates, physicians and external customers by sharing necessary information to ensure continuity of care.
• Completes all patient documentation within the defined time frame and cnsistently completes pre-certification with all appropriate information

To serve as a resource to Clinic Associates on Pre-certification specific issues

• Provide technical support to associates, seaders and providers
• Orient new associates to pre-certification functions in EPIC and other vendor specific applications
• Provide education to associates, leaders and providers on Dreyer Medical Clinic pre-certifications procedures and protocols
• Actively participates in special programs and activities designed to address needs of high-end advanced imaging pre-certification processes and acts as resource for the Clinic

Appointment Scheduling

• Make outgoing calls to patients to return to the clinic for additional views, confirm appointments and preparations and reschedule no showed and canceled appointments.
• Execute patient scheduling duties and document within the EPIC/IDX system(s) following provider specifics and scheduling guidelines.
• Collect necessary information from patient when scheduling and/or cancelling appointments and documents/updates information in EPIC/IDX system(s).
• Instruct patients on necessary preparations when booking appointments/testing using appropriate language to patient’s level of understanding guided by department protocols or technologist/provider/nurse instructions.
• All communications with callers, internal and external, are conducted in accordance with department protocol, utilizing clinic scripting where indicated.
• Schedules future appointments in multiple modalities and locations for Radiology both automatically and manually.

Telephone Communication

• Answers the telephone promptly within 3 rings.
• Utilizes outlined departmental and clinic scripting/key words.
• Restates information to ensure clarity and accuracy.
• Transfers calls when appropriate, staying on the line and announcing where and why call was transferred. Exceptions to announcing the call would include when transferring to an ACD agent.Timley, complete and accurate communication with internal and external customers

Other Duties as assigned

• Attend department meetings and clinic training.
• Maintain tracking of pre-certification activities as assigned.
• All required clinic education via ALEX.
• Special projects as assigned by direct supervisor.

Education/Experience Required:

• High school diploma or GED
• 2 years experience in a medical office setting performing related duties/functions.

Knowledge, Skills & Abilities Required:

• Professional communication and interpersonal skills.
• CRT/PC experience in a customer service setting.
• Ability to type with good accuracy.
• Familiar with MS Word, Excel, and Outlook.
• Ability to solve problems posed by callers seeking pre-certification authorizations
• Proven ability to handle difficult callers, customers and/or patients.
• Knowledge of medical terminology and ICD-9, HCPCS, CPT coding.

Physical Requirements and Working Conditions:

• Must be able to successfully complete clinic-based training for all associates.
• Ability to work with all levels of personnel.
• Ability to work under stressful situations.
• Frequent periods of extended sitting.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.