Overview
Job Summary:
Recommends the most efficient, cost-effective utilization of resources within the continuum of care, prior
to the delivery of services. Evaluates, assesses, plans, and facilitates a plan of care. Obtains/Validates
insurance prior authorizations and pre-certification for inpatient and/or outpatient healthcare services.
Some overtime and call back is required. This position is under the general direction of the leadership of
Centralized Patient Access or Baptist Connected Center-Corporate. Performs other duties as assigned
Job Responsibilities:
Assesses and evaluates clinical and financial information available and recommends the most
appropriate setting for service delivery, including level of care in order to optimize resource
consumption and reimbursement.
- Precertifies patient care services that require precertification, as identified, in a timely, efficient
manner, in order to optimize reimbursement for the patient, as well as health care providers.
- Communicates recommendations, clinical information, and fiscal information to appropriate
internal and external customers in order to facilitate optimal delivery of services and customer
satisfaction.
- Participates in the planning, data collection, and analysis phases of performance improvement
activities in order to maximize the patient placement/precertification process.
Experience:
Minimum Required
5 years of business/clinical experience in a healthcare
Preferred/Desired
8 years of business/clinical experience in a healthcare
Education:
Minimum Required
Associates degree or equivalent years of work experience.
Preferred/Desired
Bachelor's degree or equivalent years of work experience
Special Skills:
Minimum Required
Excellent communication skills. Advanced computer literacy skills
