Precertification Specialist - Maternal Fetal Medicine - Marietta

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift

Day (United States of America)

Job Summary:

The Outpatient Infusion (OPIC) Pre-Authorization Specialist functions under the direction of the OPIC Manager. Provides outstanding customer service to customers in a fast-paced busy environment. Drive volumes and increase revenue by obtaining Pre-Authorization for Outpatient Infusion in a timely Manner. Observing Quality and Productivity standards and other Key Performance Indicators. Responsible for performing a wide variety of clerical procedures that requires independent judgment, ingenuity and initiative in the utilization of computers and other equipment. Knows the existing lines of communication and authority, handles communications properly and is dependable and cooperative. Works with staff and understands appropriate scheduling and authorization process, willing to learn procedures/patient preps. Assist Scheduling, patient and physician's office staff with authorization issues in a timely manner. Communicate any authorization issues with the patient and provider within 24 hours of the patients' appointment. Make all efforts to avoid Denials, assist with Denials, claim edits, and reconsiderations when needed. Support Revenue cycle. Must be flexible with work hours to meet department needs.

Core Responsibilities and Essential Functions:

Pre-Authorization Duties - Demonstrate understanding of scheduling/Outpatient infusion. - Knowledge of CPT codes, Diagnosis codes and/or reasons for procedures (ICD-10) - Knowledge of various insurance programs offered by each carrier (TPA) - Knowledge of insurance carriers requirements for Pre-Authorization of procedures and referrals for procedures. - Knowledge of the lead time required by an insurance carrier to process pre-auth referral numbers. - Collaborates with surgical services for pre-authorizations for surgical services and care coordination for UM specific information. - Collaborates with contracted partner to overturn denials and respond to referral work queues. - Assist the physicians offices with pre-authorization process - Knowledge of electronic orders (Epic, Image Now, Trace) - Provides appropriate telephone etiquette and scripting. - Ability to type with a high degree of accuracy and computer skills to accurately input data, Pre-authorization referral number in the appropriate field in Epic to ensure claim is generated in a timely manner. - Maintain accurate and thorough notes when updating authorization status. - Obtain pre-authorization numbers from physicians offices on all required procedures. - Excellent communication and interpersonal skills to effectively deliver pending preauthorization issues to their representatives, facility and/or physician offices in a timely manner to eliminate potential revenue loss, customer satisfaction issues, patient responsibility. Explain available options (ABN, reschedule, Peer to Peer, insufficient information, Financial Responsibility form etc) - Observe the guidelines of the authorization Policy & Procedure when communicating Authorization status to our customers - Verify the accuracy of data entered and correct any errors - Superior attention to detail - Assist with monthly reports as requested - Keeps current with insurance requirements for pre-auth - Working knowledge of assigned referral work queues - Responsible for meeting the demands of the assigned facility schedule. - Assists with work queues as requested (Claim Edits, Accounts, etc) - Assume other duties as needed to support the staffing needs of the department (May be delegated on a daily basis) - Ability to exercise judgment in taking appropriate actions in emergent situations, take initiative when problem solving, retain composure in stressful situations and escalate issues as necessary - - Acts in a way that demonstrates deep personal integrity and serves as a positive example. - Acts as a liaison between the department ,facility, the system and the partner contracted financial services. Customer Focus and Communication Customer FocusEngagement (Internal and External Customers) Ability to interact respectfully with co-workers, patients, referring office staff in a friendly, personable and professional manner Promote positive working relationships with co-workers, Team Leads, Supervisors and Managers. Orientates new employees and assures proper documentation of training Assists other areas when needed Flexible with hours to meet department needs Assist in the interview process of new hires if asked Understands existing lines of communication and authority, handles communications properly and is dependable and cooperative Meets Service Recovery and Customer Service guidelines as needed Initiate escalation process if authorization cannot be obtained. Views oneself as a reflection of the organization by following through on commitments and accepting ownership of any mistakes he/she might make. Work collaboratively with the team to determine areas of optimization and develop solutions Takes responsibility for own actions, including the impact of those decisions on patients and others. Keep current knowledge of lead time required by insurance carriers to process preauth request. Assist Supervisor with training of new employees Analyze patient medical records Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

• High School Diploma / GED General

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 1 year experience in customer service and/or healthcare setting Preferred and Minimum 5 years experience in insurance/benefits Preferred and

Required Minimum Skills:

Strong customer service skills, communication skills and organizational skills. Basic typing and data entry experience. Experience in computer usage and Medical Terminology preferred. The individual must be able to communicate and understand verbal and written English language and display a positive attitude (see WellStars Standards of Gold and Values). This position requires a high level of attention to detail and a low error rate, as the consequences of even a minor mistake can be significant for patients and providers. In addition, this position requires regular, reliable attendance.

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.