Job Title: Precertification Specialist
Department: Clinic
Job Function: Responsible for reviewing and monitoring schedules to verify what services require precertification and obtaining the precertification as required for procedures or testing
Job Qualifications:
- Education:
- Minimum of one year in a clinical setting
- Minimum of 1-year customer service experience
Job Duties and Responsibilities:
- Patient health data retrieve as necessary
- Collect and record appropriate data in order to issue authorization and route request for services that require medical review to appropriate team member
- Assess and investigate requests for medical service authorization and authorize select services that do not require clinical judgment
- Review physicians' and facility schedules to determine which patients require precertification's.
- Maintains strict confidentiality related to medical records and other data.
- Participates in professional development efforts to ensure currency in health care practices and trends.
- Knowledge of:
- Clinic policies and procedures
- ICD-10 and CPT codes
- Third-party payor policies and procedures
- Computer programs and applications
- Electronic Health Records
- Customer service concepts.
- Skilled in:
- Gathering, interpreting and reporting insurance information
- Written and verbal communication
- Time management and organization.
- Ability to:
- Sort and file insurance forms and associated information
- Work effectively with patients, employees and the public
- Work in a team setting
- Other duties as assigned.
Job Relationships:
Supervises: N/A
Supervised by: Business Manager, Nuclear Cardiology Technical Director
Promotion from:
Promotion to:
This job description is not an employment contract. Employment at Kansas Heart Hospital is at-will. KHH reserves the right to alter this job description at any time without notice.
