Clinical Precertification Specialist: FT 8a-4:30p

4 weeks ago

Sandusky, United States Firelands Health Full time
Position Highlights:

  • Work/life: You will find support to help you manage your personal life while building a career.
  • Employee-centric: Tuition reimbursement, loan forgiveness, comprehensive major medical, dental and vision insurance, paid time off, 401(k), health and wellness offerings, monthly employee events, and more.
  • Lifestyle: Sandusky was voted “Best Coastal Small Town in America”. You will have the opportunity to enjoy living and working in this growing area along the beautiful shores of Lake Erie.
About Firelands Health:

Our goal at Firelands Health is to be the best & preferred independent healthcare employer for the Sandusky Bay region.

Firelands Health is the area’s largest and most comprehensive resource for quality medical care. We are “big enough to care for you, and small enough to care about you”. We are locally managed and governed as a not-for-profit healthcare facility, serving the counties of Erie, Ottawa, Sandusky, and Huron, covering a regional service area with over 300,000 residents. Our mission is to provide excellent healthcare, promote community wellness, and improve the lives we serve.

Our Core ACE Values: Attitude: We choose to be positive and inclusive every day. Commitment: We are committed to exceed the expectations of those we serve. Enthusiasm: We will work passionately to make a difference.

What You Will Do:
  • Concentration is on prior authorization, precertification and verification of insurance benefits for various services and payers including, but not limited to Managed Care, Commercial/WC payers, Medicare, and insurances secondary to Medicare.
  • Contacts commercial payers as necessary to obtain initial pre-certification and coordinates information to central scheduling, financial counselors or care management for utilization review. In the event of an admission, communicate the number of initial days authorized for admission.
  • Documents on the patient’s Meditech account information obtained regarding insurance benefits, the name of the Insurance Company representative providing the information, their telephone number, the date the information was obtained, a reference number for the call, and an authorization number when necessary.
  • Obtains outpatient authorizations, sleep lab, dialysis, outpatient diagnostic testing, invasive in and or outpatient procedures.
  • Works closely with insurance verification staff, care management and patient access regarding payer information changes so ADT and Patient accounting systems can be updated to ensure accurate billing.
  • Monitors and tracks scheduled surgeries and FRMC Clinics on a daily basis for add-ons. Verifies eligibility, ensuring authorization is in place prior to procedure. Notifies/Contacts MD office, and/or care management in the event additional information is needed to properly authorize the patient stay.
  • Act as a liaison between central scheduling, registration, care management, insurance verification and the physician’s offices.
What You Will Need:
  • Graduate of an accredited program of professional nursing.
  • Possess a current LPN/RN license from State of Ohio.
  • Two – three years’ experience as a Clinician required.
  • Good working knowledge of medical terminology, ICD9/ICD10 coding and understanding of managed care.
  • Medical terminology background.
  • Experience in the business office medical setting.
  • Ability to independently assume other responsibilities in addition to routine duties as assigned by the Director.


Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

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