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Pre Certification Representative

3 months ago

Oklahoma City, United States Surgical Hospital Of Oklahoma Llc Full time
Job DescriptionJob Description

Pre-Certification Representative

What You’ll Do

The Pre-Certification Clerk works with insurance companies, provider offices, and other stake holders to obtain pre-certification for surgeries scheduled at the hospital. The position is responsible for ensuring that all patient insurance eligibility benefits and pre-certifications are verified before patient is admitted. Duties include compiling, computing, recording, and billing for Medicare and Medicaid, and any other payers, as well as all follow-up for these payers that may be required.

The Successful Candidate Will Be Able To

Collaborate with other professional disciplines to ensure effective and efficient patient care delivery and the achievement of desired patient outcomes

Maintain confidentiality with all information

Perform any and all other duties as assigned

Essential Functions

  • Responsible for ensuring that all patient insurance eligibility benefits and pre-certifications are verified before patient is admitted. Compile, compute, records, and bill for Medicare and Medicaid, and any other payers as well as all follow-up for these payers that is required.
  • Performs Insurance verification for all surgeries.
  • Ensure pre-cert has been received by date of surgery and obtain additional information to be input in system.
  • Input of all benefits and certification information into the proper locations in the system as well as adding patients insurance data and inspecting any changes in insurance and requesting any changes when applicable.
  • Work with Case Management when appropriate.
  • Expert knowledge of managed care benefits and commercial insurance benefits, to assist patient with questions.
  • Review incoming correspondence from insurance companies recording authorization information in system.
  • Ensure all correspondence and surgery work product have all pertinent information for patient admission.
  • Input all notes in computer.

Job Type: Full-time

Benefits:

  • 401(k)
  • 401(k) matching
  • AD&D insurance
  • Dental insurance
  • Disability insurance
  • Employee assistance program
  • Employee discount
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Schedule:

  • 8 hour shift
  • Day shift
  • Monday to Friday
  • Overtime possible


Experience:

  • Pre-Certification: 1 year (hospital, ASC, or surgeon office preferred)