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Pre-Certification Specialist

1 month ago

Bethlehem, United States St. Luke's Hospital Full time


St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

The Pre-Certification Specialist is responsible for contacting health insurance companies prior to procedures, testing or admission to the hospital to verify coverage either online or by telephone. The precertification specialist is also responsible for relaying precertification information to performing facility and for facilitating appeals if initial approval denied.

JOB DUTIES AND RESPONSIBILITIES:

  • Receives instructions from the physician regarding what procedure or testing is needed

  • Obtains precertification/pre-authorization from insurance companies prior to procedure or testing utilizing an online application or contacting the insurance company by telephone

  • Verifies and completes patient eligibility, coverage verification, and benefit investigation  for the procedure using an online application or by telephone.  If the patient is not eligible on date of service or procedure is not covered, this information is relayed to the physician and the patient

  • Maintains online log of patient’s requiring precertification

  • Maintains working knowledge of Navinet (online precertification application)

  • Responds to written and telephone inquiries from patients, insurance carriers and facilities regarding planned services

  • Maintains detailed knowledge of computer software systems as it relates to job functions

  • Analyzes current procedures, bringing suggestions for improvement to the attention of team members and team lead/supervisor/manager/director consideration

  • Document authorizations in medical record and provide to appropriate sources

PHYSICAL AND SENSORY REQUIREMENTS:

Sitting up to eight hours a day. Continually use fingers for typing and writing.  Routinely use upper extremities. Stoop, bend and reach above shoulder level regularly. Vision must be correctable to 20/20 and hearing must be in the normal range for telephone calls. Position also requires viewing computer screens and typing for long periods of time.

EDUCATION:

High School diploma required.

TRAINING AND EXPERIENCE:

Previous precertification experience helpful.  Medical coding and terminology experience preferred.

Please complete your application using your full legal name and current home address.  Be sure to include employment history for the past seven (7) years, including your present employer.  Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable.  It is highly recommended that you create a profile at the conclusion of submitting your first application.  Thank you for your interest in St. Luke's

St. Luke's University Health Network is an Equal Opportunity Employer.

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