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Job Details

Description

Position Summary:  On a daily basis the Lead Pre-certification rep oversees the functions of prior authorization for both inpatient admissions and outpatient procedures.  The Lead rep works to support all aspects of these processes, including CPT coding, ICD10 assignment, providing problem solving and resource information for staff to insure reimbursement is maximized.  Other responsibilities include performing verification of benefits, pre-authorization for elective and emergency admissions and obtaining Notices of Admissions.  Additional duties may include assisting the Department of Patient Access Services in implementing new software.   Responsible for staying abreast of all insurance regulations and requirements and training PAS staff on any insurance changes.  Position requires self-motivated individual who can handle high patient volumes and fast pace.  In addition, this person�s works as a liaison with the Finance Department, providers and insurance companies to assure testing is approved and reimbursement is maximized.  Is responsible to prepare and/or support programs developed and implemented by the Department Director.

Experience:

Required: 3-5 years� hospital or health care setting providing patient access, insurance eligibility and authorization, excellent communication skills.  

Preferred: CPT coding and/or billing services,  Medical Terminology, Anatomy and Physiology, experience with CPT coding and previous supervisory experience.

Education:  High School, GED or equivalent required.  B.S. preferred.

License and Credentials:  AAPC CPC certification preferred.

Required Skills:  Proven organizational, customer relations, decision making, and critical thinking skills. Knowledge of basic clinical functions.  Strong insurance background, computer proficiency required.

Bi-Weekly Hours: 80

Work Schedule: M - F

Qualifications