Precertification Specialist | Central Scheduling | Memorial Health

What you'll do: 

• Reviews precertification requirements and submits for precertification for the following services; Advanced Imaging, Elective Inpatient Admissions, Endoscopy, Multipurpose Cath Lab, Non-Invasive Cardiovascular Lab, Sleep Studies, and Surgical services. Reviews applicable Hospital Information System (HIS) authorization workqueues daily to ensure testing/procedures requiring precertification is reviewed and completed timely.
• Reviews HIS reports for surgical case creation to proactively validate insurance network status before the case is scheduled. Notifies surgeon’s offices of out-of-network insurance, advising the patient’s financial responsibility will be increased. Completes timely submission of precertification if required by the patient’s insurance plan(s) via online payor websites, fax or phone. Ensures precertification is submitted for the correct patient class and intended CPT / procedure codes.
• Reviews the patient’s medical record for additional clinical information to support the precertification request. If not documented in the HIS, requests additional clinical information from the ordering provider office in order to complete the precertification process.
• Scans all precertification determinations to the patient’s medical record and updates the referral record accordingly with authorization status, communications, approved/pending authorization numbers, call reference numbers and approval dates. Communicates insurance precertification peer-to-peer options to the ordering provider’s office, if made available by the payor.
• Correctly identifies patients by verification of three primary identifiers. Avoids duplicate medical record number (MRN) creation and reports duplicate MRNs when discovered.
• Reviews and transcribes faxed documents into the HIS accordingly. Distributes faxed documentation as necessary to team members.

Requirements 

High school diploma or equivalent; personal computer/data entry experience preferred; six months working in the healthcare environment preferred; experience with Microsoft Word, Excel and Outlook preferred; strong telephone and interpersonal communication skills; teambuilding skills; understanding of medical terminology, medical insurance precertification knowledge preferred; excellent customer service skills. 

Shift

1st

Hours
80 hours per pay 

Benefits
• Medical Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Flexible Spending Account

Time Off
• Vacation
• Sick Leave
• 11 Paid Holidays
• Personal Day

Retirement
• Ohio Public Employee Retirement System
• Deferred Compensation

Other
• Tuition Reimbursement
• Kidzlink Daycare Center
• Employee Recognition
• Free Parking
• Wellness Center
• Competitive Salaries
• Community/Family Atmosphere

Location:

• Approx. 25 minutes away from Dublin, OH
• Approx. 30 minutes away from Hillard, OH
• Approx. 30 minutes away from Delaware, OH
• Approx. 30 minutes away from Powell, OH

We look forward to seeing your application!

It is our commitment to inclusivity and diversity and our ongoing determination to provide a welcoming and inclusive environment for all staff and guests of the Hospital, regardless of age, color, disability, gender, gender expression or gender identity, genetic information, national origin, race, religion, sexual orientation, or veteran status. For any questions or needed accommodations, please contact Memorial Health Human Resources at 937.578.2701.