Tier 1 Precert Specialist

POSITION SUMMARY

Responsible for all aspects of assigned patient pre-certification of surgery

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statement(s)

• Verifies and updates insurance information and demographics

• Pre-certifies all surgeries

• Reviews insurance eligibility

• Keeps up with changes in billing and pre-cert guidelines (Including LDC’s)

• Reports denial trends to coders and manager

• Reviews insurance eligibility and rejections/errors

• Enters authorization information into Athena

• Follows-up with aging buckets

• Scans surgery scheduling sheets to Athena

• Enters surgeries on the Excel spreadsheet and scheduling book for each doctor

• Determines and reviews financial responsibilities and insurance coverage with patients

• Reviews surgery costs and establishes payment plans for patient portion

• Keeps up with changes in payor processes and reports them to coordinator for appropriate action

• Obtains all pre-certifications

• Responds to correspondence from payors and patients

• Regular and predictable attendance

• Ability to work in a cooperative manner with others

• Performs other duties as assigned

SKILLS & ABILITIES

Education: High School Graduate or General Education Degree (GED)

Experience: Previous healthcare billing experience is required

Computer Skills: Must be computer literate. Basic computer skills required. Must be able to type.

Campbell Clinic Benefit Summary: 

Campbell Clinic offers a lucrative benefit package to support employees and their families.

• Medical / Dental / Vision Insurance
• HRA Option
• Flexible Spending Account 
• Basic Life Insurance 
• Voluntary Life Insurance Option
• Long-Term Disability
• Voluntary Short-Term Disability 
• Accident Insurance 
• Critical Illness Insurance
• 401(k) Plan Matching + Profit Sharing 
• Employee Assistance Program 
• Paid Time Off 
• Personal/Sick Time 
• Paid Holidays 

ADA Disclaimer:  In developing this job, description care was taken to include all competencies needed to successfully perform in this position.  However, for Americans with Disabilities Act (ADA) purposes, the essential functions of the job may or may not have been described for purposes of ADA reasonable accommodation.  All reasonable accommodation requests will be reviewed and evaluated on a case-by-case basis.

Equal Opportunity Employer/Veterans/Disabled