New job Pre Certification Clerk in Wyoming

ROLE SUMMARY

The Pre Certification Clerk is responsible for obtaining all prior authorizations as required per insurance guidelines. This position is responsible for communication with patients or appropriate clinical departments regarding insurance approval/denial. The Pre Certification Clerk will also coordinate Peer-to-Peer reviews and communicate with Physicians, offices, and departments all necessary information needed to complete the authorization for services. Acts as an authority on admission criteria and insurance expectations. This position is required to work closely with clinical and billing departments, utilizing their knowledge of both areas.

CORE RESPONSIBILITIES

• Reviews all prescheduled diagnostic procedures and surgeries on a daily basis.
• Reviews all diagnostic and surgery registrations for accuracy; identify and reconcile all errors.
• Verifies all diagnostic, surgical, and inpatient admissions, including eligibility & benefits on all worker’s compensation, and high-risk outpatients (e.g., motor vehicle or third party liability).
• Obtains and document precertification, certification, and/or proper referral during the verification process.
• Completes all necessary forms and paperwork (e.g., pre-admit diagnostic, surgeries).
• Creates, if necessary, any pre-scheduled registrations that have not been completed prior to date of service, and route them to appropriate location.
• Re-checks all inpatients for accuracy.
• Runs estimates, prior to visit and notify patient of financial responsibility.
• Runs ABN’s and financial letters as needed.
• Contacts MD office when authorization/referrals are pending to evaluate how to proceed as needed; contacts patient after resolution with MD office.
• Double checks social data for any errors, patient data, guarantor data, and reconcile if necessary to avoid problems on bill, communicate changes to appropriate departments.
• Maintains a high level of customer service/satisfaction in pre-admissions; this is accomplished by timely and accurate completion of all duties as outlined above.

The above statements are intended to describe the general nature and level of work performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified and employees may be required to perform other duties as assigned.

SKILLS, KNOWLEDGE, AND ABILITIES

• Excellent verbal, written and interpersonal communication skills
• Strong knowledge of the admission process
• Knowledge of both government and a non-government payer
• Demonstrate a basic understanding of hospital insurance contracts to determine if treatment and services are covered by insurance at facility
• Demonstrate an independent work initiative, sound judgment and attention to detail and the ability to handle multiple tasks simultaneously
• Proficient with standard office equipment
• Knowledge of medical terminology