Precertification Specialist

Overview:

WE ARE HIRING!
Location: 401 E. Chestnut Street Louisville, KY 40202 

About Us

UofL Physicians is one of the largest, multi-specialty physician practices in the Kentuckiana region. With over 700 providers, 200 practice locations and 78 specialties, UofL Physicians’ academic and community physicians care for all ages and stages of life, from pediatrics to geriatrics with compassion and expertise. UofL Physicians academic providers are professors and researchers at the UofL School of Medicine, teaching tomorrow’s physicians, leading research in medical advancements and bringing the most progressive, state-of-the-art health care to every patient.

With more than 13,000 team members – physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care.

Our Mission
As an academic health care system, we will transform the health of the communities we serve through compassionate, innovative, patient-centered care.

Job Summary:

The Precertification Specialist sets the precedence to ensure a positive patient experience for upcoming surgical procedures and diagnostic tests by accurately and efficiently completing all necessary steps related to prior authorization, medical necessity determination and financial clearance for the hospital system and physician services for clinics, adult acute facilities and diagnostic centers.

• Accurately and efficiently identifies all appropriate and necessary clinical documentation to support medical necessity for all scheduled procedures/medication orders for multiple service lines and clinics.
• Submits authorizations and clinical information to the appropriate payer/benefit manager in a timely fashion in compliance with plan rules including appropriately utilizing the CMS IP Only list.
• Assesses orders to determine appropriate patient class and works with physicians to clarify as necessary
• Contacts insurance plan/payers to determine eligibility, coverage information for specific procedures and benefit information
• Coordinates patient encounters using multiple systems applications, various registration applications, clinical operating systems, eligibility verification systems and medical necessity applications.
• Documents all findings/communications thoroughly and accurately in the patient record.
• Meets or exceeds productivity standards in the completion of daily assignments and accurate production.
• Documents all authorization information accurately in the referral as necessary to produce a clean transaction with the payer.
• Answer and responds to all communications through multiple applications in a timely and professional manner to ensure a positive patient experience.
• Complies with all departmental and organizational policies and procedures.
• Complies with local, state, and federal rules and regulations and the requirements of accrediting bodies.
• Prioritizes work according to the department, hospital, and patient needs.
• Independently works to resolve patient and provider questions related to prior authorizations, referrals, and insurance verification.
• Acts as a liaison between the patient, payer, provider and clinical support staff.
• Responsible for managing/setting up peer to peers and/or appeals for providers in a timely and professional manner according to individual plan guidelines.
• Work with all necessary parties to ensure patients are rescheduled/ notified of denials promptly.
• Responsible for understanding and staying current and up to date on payer regulations.
• Accurately provide expected timeframes /payer guidelines to patients and providers regarding prior authorization/ financial clearance.

• Maintains compliance with all company policies, procedures and standards of conduct
• Complies with HIPAA privacy and security requirements to maintain confidentiality at all times

Performs other duties as assigned

Education:

• High School Diploma or equivalent (required)

Experience:

• At least one year of patient access, insurance verification, prior authorization, or related experience (required)
• 3 years of prior authorization or related experience (preferred)
• Medical Terminology preferred