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Precertification Specialist

2 months ago

Louisville, Kentucky, United States UofL Health Full time
About the Role

We are seeking a highly skilled Precertification Specialist to join our team at UofL Health. As a key member of our organization, you will play a critical role in ensuring a positive patient experience by accurately and efficiently completing all necessary steps related to prior authorization, medical necessity determination, and financial clearance for hospital services and physician services.

Key Responsibilities
  • Prior Authorization and Medical Necessity Determination
    • Accurately and efficiently identify all necessary clinical documentation to support medical necessity for scheduled procedures and medication orders.
    • Submit authorizations and clinical information to payers in a timely manner, in compliance with plan rules.
  • Insurance Verification and Eligibility
    • Contact insurance plans and payers to determine eligibility, coverage information, and benefit details for specific procedures.
  • Coordination and Communication
    • Coordinate patient encounters using multiple systems applications, registration applications, clinical operating systems, eligibility verification systems, and medical necessity applications.
    • Document all findings and communications thoroughly and accurately in the patient record.
  • Productivity and Quality
    • Meet or exceed productivity standards in the completion of daily assignments and accurate production.
    • Document all authorization information accurately in the referral to ensure a clean transaction with the payer.
  • Communication and Liaison
    • Respond to all communications through multiple applications in a timely and professional manner to ensure a positive patient experience.
    • Act as a liaison between patients, payers, providers, and clinical support staff.
Requirements
  • Education
    • High School Diploma or equivalent (required)
  • Experience
    • At least one year of patient access, insurance verification, prior authorization, or related experience (required)
    • 3 years of prior authorization or related experience (preferred)
What We Offer

As a Precertification Specialist at UofL Health, you will have the opportunity to work in a dynamic and patient-centered environment. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.