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Post Acute Pre-Certification Specialist - 40 hrs/wk. Job in Findlay, Ohio US
Monster
 
 
 
 

Job Summary

Company
Blanchard Valley Regional Health Center
Location
Findlay, OH
Industries
Government and Military
Job Type
Full Time
Employee

Post Acute Pre-Certification Specialist - 40 hrs/wk.

About the Job

PURPOSE OF THIS POSITION

The Post-Acute Pre-Certification Specialist is responsible for initiating and obtaining new insurance authorization requests for post-acute services. Works collaboratively with the case management team, hospital care team, community partners and insurance companies to ensure that patient care needs are met regarding post-acute care prior authorizations. Obtains and maintains contacts with insurance companies to streamline barrier removal. Maintains knowledge of proper portal functionality and medical necessity requirements for post-acute care. Understands payer requirements and how to apply benefits in various circumstances for post-acute care and is responsible for identifying medical criteria for post-acute care from chart review and developing an effective clinical packet to justify the level of care needed.

JOB DUTIES/RESPONSIBILITIES


* Duty 1: Initiates and manages the pre-certification process for patients transferring to post-acute care. This includes collecting necessary patient information, submitting requests to insurance companies via portals, websites, or other required methods, and tracking the status of authorizations.

* Duty 2. Communicates with interdisciplinary teams. Works closely with clinical staff, physicians, and other relevant departments to gather necessary clinical documentation and facilitate the approval process.

* Duty 3. Organizes and maintains accurate documentation. This includes patient records, clinical documentation, and all correspondence related to authorization requests.

* Duty 4. Addresses and manages denials, communicates denied authorization requests to relevant parties and facilitates the appeals process for post-acute care placement.

* Duty 5. Documents all activities and communications related to the pre-certification process within relevant systems (e.g., EHR, patient management systems).

* Duty 6. Maintains positive relationships with managed care providers and works to ensure patient and provider satisfaction.

* Duty 7. Stays updated on payer policies and requirements and acts as a resource to team members and patients.

* Duty 8. Complies with HIPAA regulations and ensures confidentiality of patient information.

* Duty 9. Demonstrates excellent communication, organizational, and problem-solving skills.

* Duty 10. Utilizes relevant technology and software platforms. This includes EHR systems, prior authorization management software, and insurance portals.
REQUIRED QUALIFICATIONS


* High School Diploma or GED equivalent.

* Previous experience in a medical office, hospital, or skilled nursing setting, specifically with managed care pre-certification.

* Knowledge of Medicaid, Medicare and Managed Care procedures.

* Understanding of insurance verification and authorization processes.

* Familiarity with medical terminology and coding (CPT/ICD-10).

* Proficiency in using computer systems, including Microsoft Office applications and relevant healthcare software (e.g., EHR systems, insurance portals).

* Strong organizational and time management skills.

* Excellent communication and interpersonal skills.

* Ability to work independently and as part of a team.

* Detail oriented and accurate.

* A valid driver's license is required (if you do not have a valid Ohio driver's license you must obtain one within 30 days of your residency in the state). You must also meet BVHS's company fleet policy and insurance company requirements, and any other requirements that may be required to operate a vehicle.

* Positive service-oriented interpersonal and communication skills required.

* Individual must be able to demonstrate the knowledge and skil

Apply here: https://www.aplitrak.com/?adid=YmJnZW5lcmljLjYyNTg5LjEwNTA4QGJsYW5jaGFyZHZhbGxleWNvbXAuYXBsaXRyYWsuY29t
 
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