Surgical Precertification Coordinator
3 weeks ago
Schedule: Monday to Friday, 8:30am to 5pm
As a Surgical Precertification Coordinator at Stamford Health, you will be responsible for obtaining insurance precertification/authorization for procedures, surgeries, and diagnostic services on behalf of the patient and the Practice. This includes accurate and complete patient registration in the electronic scheduling and billing system, insurance verification and updates, contacting third-party payers via phone, fax, and internet to obtain necessary approvals, and communicating results to the patient, physician, and other staff.
This position requires a working knowledge of Medicare, Medicaid, and Commercial insurance plans, medical terminology, billing, and supervisory experience. It demands strong verbal and written communication, customer service, and organizational skills.
Responsibilities- Perform timely insurance verification/eligibility processes utilizing the practice management system, automated electronic eligibility functionality, various reports, and third-party payer websites and customer service telephone contacts related to ordered/scheduled procedures.
- Ensure that all insurance, demographic, and eligibility information is obtained and entered into the system in an accurate manner per established Practice policies and procedures. Communicate with patients to identify missing information and make corrections as needed.
- Contact insurance companies on behalf of the Practice and the patient to initiate and complete the precertification/authorization process as required by the patient's insurance company for ordered procedures, surgeries, and diagnostic testing.
- Coordinate with insurance companies, physicians, and patients to provide all appropriate documentation required for the precertification/authorization of services, including but not limited to the medical record, procedural (CPT) and diagnostic (ICD10) coding, and Letters of Medical Necessity per the established procedures of each insurance carrier and the Practice.
- Perform and document tracking and follow-up on all open precertification/authorization requests in a timely manner. Provide additional information to carriers as requested.
- Coordinate peer review requests from insurance carriers with the ordering physician.
- Notify physician and other Practice staff and/or patient when services are not approved. Know the process and protocols for appealing precertification decisions and coordinate an appropriate response as determined by the physician.
- Keep records of all activities related to the precertification/authorization process, including but not limited to method of contact, dates of follow-up, contacts, and phone numbers, and all reference numbers. Document information given or received to support actions taken.
- Document approval/denial of precertification/authorization for services in the electronic medical record per established policies and procedures. Scan appropriate documents to the patient's chart for reference.
- Work in conjunction with the surgical scheduler to ensure cohesive communication and coordination for scheduled procedures, surgery, and diagnostic services.
- Coordinate deliveries of specialty pharmacy medications, responsible for cataloging pharmaceuticals in electronic health systems, and for ensuring timely arrival and availability of medication for scheduled patients.
- Develop and maintain a working knowledge of the procedures performed and ordered by the Practice. Have a working knowledge of CPT and DX coding.
- Research third-party payer requirements and processes for precertification/authorization requirements pertaining to services provided by the Practice. Develop and maintain reference guides and resources related to processes. Communicate changes in authorization processes, insurance policies, and billing requirements to appropriate Practice staff.
- Monitor and review the patient registration, data entry into the system, and charge captures for timeliness, accuracy, and thoroughness to ensure optimal charge capture for services rendered.
- Assist the Revenue Cycle Department in researching and resolving denied claims for precertification/authorization.
- Assist the surgical scheduler in scheduling surgeries and coordinating pre-operative requirements when needed.
- Identify all patients without third-party financial benefits and direct them to financial counseling according to Financial Counseling and Revenue Cycle policies and procedures.
- Responsible for generating Good Faith Estimates for procedures, surgeries, and diagnostic services in accordance with the No Surprise Act policies and procedures.
- Provide high-level customer service to internal and external customers. Have the ability to explain and educate patients and staff regarding complicated insurance processes.
Qualifications
- High School diploma is required; Associates Degree is preferred.
- 1 to 2 years of previous insurance verification, pre-certification/pre-authorization, medical billing, or other related experience in a healthcare environment.
- Competency with computers, electronic medical records, the Internet, and computer software such as MS Office or equivalent is required.
- Knowledge of medical office operations, coding, and billing, medical terminology, and third-party insurance processes is required.
- Demonstrated ability to prioritize and manage multiple tasks and demands given tight time constraints while ensuring a high degree of accuracy and attention to detail. Must be able to manage time efficiently with minimal supervision.
- Demonstrated ability to maintain confidentiality of all records per State, Federal, and Practice laws, guidelines, policies, and procedures.
- Strong verbal, written, organizational skills, and ability to work in a fast-paced environment.
- The ability to work with individuals at all organizational levels, particularly peers, team members, other departments, patients, and the community is required.
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