Pre-Certification Representative II
Endeavor Health, Skokie, IL, United States
Hourly Pay Range
$20.69 - $30.00 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.
Position Highlights
Position: Pre-Certification Rep II
Location: Skokie, IL
Full Time/Part Time: Full time
Hours: Monday-Friday, standard business hours, 8am-4:30pm
Position Summary Under 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.
What You Will Do
Submits 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.
Communicates 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.
Communicates negative payer determinations (denied authorizations) to ordering physician / department to facilitate decision making in clinical next steps.
Communicates 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.
Documents outcomes and statuses related to all referral and pre-certification requests in Epic. This includes approvals, denials, status, outcomes, etc.
Consistently follows prescribed workflows, standards and protocols for managing and obtaining referrals, authorizations and priorities.
What You Will Need
Education: High School Diploma.
Experience: 1 year of related insurance experience required. Registration and billing experience preferred. Experience with referral and pre-certification initiation, processing and coordination strongly preferred.
Benefits
Career Pathways to Promote Professional Growth and Development.
Various Medical, Dental, Pet and Vision options.
Tuition Reimbursement.
Free Parking.
Wellness Program Savings Plan.
Health Savings Account Options.
Retirement Options with Company Match.
Paid Time Off and Holiday Pay.
Community Involvement Opportunities.
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
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Position Highlights
Position: Pre-Certification Rep II
Location: Skokie, IL
Full Time/Part Time: Full time
Hours: Monday-Friday, standard business hours, 8am-4:30pm
Position Summary Under 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.
What You Will Do
Submits 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.
Communicates 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.
Communicates negative payer determinations (denied authorizations) to ordering physician / department to facilitate decision making in clinical next steps.
Communicates 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.
Documents outcomes and statuses related to all referral and pre-certification requests in Epic. This includes approvals, denials, status, outcomes, etc.
Consistently follows prescribed workflows, standards and protocols for managing and obtaining referrals, authorizations and priorities.
What You Will Need
Education: High School Diploma.
Experience: 1 year of related insurance experience required. Registration and billing experience preferred. Experience with referral and pre-certification initiation, processing and coordination strongly preferred.
Benefits
Career Pathways to Promote Professional Growth and Development.
Various Medical, Dental, Pet and Vision options.
Tuition Reimbursement.
Free Parking.
Wellness Program Savings Plan.
Health Savings Account Options.
Retirement Options with Company Match.
Paid Time Off and Holiday Pay.
Community Involvement Opportunities.
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
#J-18808-Ljbffr