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Pre-Certification Coordinator

2 months ago

Charleston, West Virginia, United States CAMC Health System Full time
Position Overview


The Pre-Certification Coordinator is responsible for ensuring the accurate procurement of pre-certification authorizations and referrals for both returning and new patients. This role also involves the meticulous review and completion of patient charts.

The coordinator will manage the scheduling of various physician-ordered tests, examinations, and surgeries as necessary.

Key Responsibilities

  • Conduct daily assessments of patient charts to identify the need for pre-certification or referrals.
  • Analyze patient insurance information to ascertain medical necessity for specific treatments.
  • Liaise with Medicare and various insurance providers to gather essential data regarding compliance, authorizations, verifications, progress notes, medical necessity guidelines, and pre-certification requirements.
  • Execute clerical tasks as required, including drafting correspondence to patients, insurance companies, and referring physicians regarding any pertinent issues.
  • Schedule patient surgeries as per physician directives and relay all necessary information to relevant parties.
  • Facilitate additional referrals to other physicians based on the review of test or scan results by the physician.
  • Create new patient accounts in the billing system upon receiving referrals from physicians and ensure all relevant information is forwarded to the appropriate personnel for inclusion in the medical records.
  • Stay updated on continuing education regarding treatment trends, current medical terminology used in pre-certification, and relevant coding systems such as ICD-10, CPT, and HCPCS.
  • Cross-train for front desk and medical assistant roles, providing backup support as needed.
  • Schedule all procedures, and manage the collection, application, and deposit of all funds.
Required Knowledge, Skills & Abilities


For positions involving direct patient interaction, the employee must acquire and demonstrate the necessary knowledge and skills to provide developmentally appropriate assessment, treatment, or care as defined by the department's identified patient demographics.

Specifically, the employee must exhibit competency in: 1) the ability to gather and interpret information based on patient needs; 2) understanding of growth and development; and 3) knowledge of the range of treatments required by patients.

Competency Requirements Must demonstrate competency through initial orientation and ongoing validation to independently perform tasks and additional duties as outlined in the job description and the specific competency checklist for the unit/department.

Common Duties and Responsibilities

1. Maintain and document all required educational credentials.

2. Exhibit positive customer service and foster good relations with co-workers.

3. Adhere to the company's attendance policies.

4. Engage in continuous quality improvement initiatives within the department and organization.

5. Conduct work in a cost-effective manner.

6. Perform duties in accordance with departmental pay practices and scheduling policies, including overtime, shift work, and on-call situations.

7. Align work with the overall mission and strategic objectives of the organization.

8. Follow organizational and departmental policies and procedures as applicable.

9. Undertake related duties as assigned.


Education Requirements

  • High School Diploma or GED required.
Credentials

  • No specific certification, competency, or license required.
Work Schedule: Days

Status: Full Time Regular

Location: General-MSOB

Talent Acquisition Specialist: An authorized representative.