Pre-Certification Representative II

divh2Pre-Certification Rep II/h2pHourly Pay Range: $20.69 - $30.00 - The hourly pay rate offered is determined by a candidates expertise and years of experience, among other factors./ph3Position Highlights/h3pstrongPosition:/strong Pre-Certification Rep II/ppstrongLocation:/strong Arlington Heights, IL/ppstrongFull Time/Part Time:/strong Full time/ppstrongHours:/strong Monday-Friday, standard business hours, 8am-4:30pm/ph3Position Summary/h3pUnder the management of the Manager, Patient Access, the Pre-Certification Representative II is responsible to initiate and manage referrals/pre-authorization/pre-certification based on clinical orders for an assigned patient population. In addition, the Pre-Certification Representative II is responsible to determine insurance eligibility and, as appropriate, benefits and medical necessity requirements based on patient specific insurance. The Pre-Certification Representative II provides these services to ensure that our customers are provided a high quality experience which includes understanding of patient responsibility and ease of access to clinical services. This is achieved through coordination with and education of the patient. The Pre-Certification Representative II helps to insure that patient satisfaction and loyalty are achieved while hospital and Medical Group revenue is optimized./ph3What You Will Do/h3ulliSubmits referral and/or pre-certification requests for physician visits, diagnostic testing, procedures, durable medical equipment, home care and all other medical care services, per individual carrier procedures./liliCommunicates and coordinates with office or physician if payer specific additional clinical information of physician peer to peer is necessary to successfully process the referral or pre-certification./liliCommunicates negative payer determinations (denied authorizations) to ordering physician/department to facilitate decision making in clinical next steps./liliCommunicates third party payer decision on authorization/pre-certification to patient. This includes communication and education of patient regarding patient specific insurance carrier requirements and possible out of pocket patient responsibility./liliDocuments outcomes and statuses related to all referral and pre-certification requests in Epic. This includes approvals, denials, status, outcomes, etc./liliConsistently follows prescribed workflows, standards and protocols for managing and obtaining referrals, authorizations and priorities./li/ulh3What You Will Need/h3ullistrongEducation:/strong High School Diploma/lilistrongExperience:/strong 1 year of related insurance experience required. Registration and billing experience preferred. Experience with referral and pre-certification initiation, processing and coordination strongly preferred./li/ulh3Benefits (For Full Time or Part Time Positions)/h3ulliCareer Pathways to Promote Professional Growth and Development/liliVarious Medical, Dental, Pet and Vision options/liliTuition Reimbursement/liliFree Parking/liliWellness Program Savings Plan/liliHealth Savings Account Options/liliRetirement Options with Company Match/liliPaid Time Off and Holiday Pay/liliCommunity Involvement Opportunities/li/ulpEndeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) all recognized as Magnet hospitals for nursing excellence./ppWhen you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential./ppEndeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information./ppDiversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all./ppEOE: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor./p/div