Precertification Coordinator, Full-Time, Days

4 weeks ago


West Columbia, United States Prisma Health Full time

Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for the financial and clinical aspects of all referrals made to the program, including logging all referrals, collecting and verifying pertinent demographic and financial data as well as obtaining pre-certifications and authorizations for new and ongoing treatment.

Interacts regularly with internal customers, third party payors and outside referral sources.

Performs complex tasks using Microsoft Office applications.

Responsible for compliance issues related to medical necessity and coding.

Accountabilities

* Processes and tracks incoming referrals. Logs all incoming referrals according to program guidelines. Obtains medical records to support referrals. Prepares referral with clinical and financial information for submission to Program Director. Coordinates patient assignment to case management and communicates with referral source as to the status of the referral. 25% * Advocates for and secures coverage for all patients referred for services. Explains the unique aspects of the program to insurance representatives and provides the program description to all third party payors in order to increase accuracy of pre-certification determinations and financial information. Verifies insurance benefits to include all possible services and CPT codes billed by program and need for pre-certification or pre-authorization for treatment. Pursues any needed clarification of insurance benefits prior to scheduling of patients. Obtains staffing requirements related to third party payors based on requirements for in-network providers and communicates information to case management to maximize reimbursement. Maintains public relations with patients and third party payors, including insurance case managers, in accordance with GHS Service Excellence standards. 25% * Collects and verifies pertinent patient demographics and financial data on all new patient referrals with physician offices and other referral sources. Communicates with referral source to obtain additional information required for completing referral, including ICD-9 coding as well as ascertaining appropriate medical records to determine eligibility for program admission. 15% * Collects and verifies pertinent patient demographics and financial data on all ongoing patients under continuing treatment. Obtains continuing authorizations for treatment under 3rd party payor guidelines andtime framesand completes required documentation. Facilitates documentation needs by third party payors for continuing treatment. Provides initial advocacy and informational needs for recurring treatment withthirdparty payors and notifies case management ofadditionalcontact required. 15% * Performs compliance functions related to coding, billing, demographics and and payor source. Facilitates ICD-9 codes on initial orders. Coordinates supplemental ICD-9 coding to support medical necessity of treatment and communicates to GHS Medical Information Department in a timely manner. Monitors timeliness of physician continuing orders for treatment for all program and PRN patients. 10% * Performs multiple business office functions using MS Office applications. Coordinates patient scheduling process, updates waiting lists, prepares written communication to physicians regarding referrals and performs database entry. 10%

Supervisory/Management Responsibilities

This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Education

High School diploma or equivalent Minimum Experience

2 years-Insurance, billing, collections, customer service and/or healthcare business office. Other Required Experience

Knowledge of ICD-10 and CPT coding conventions- Preferred Work Shift Day (United States of America)

Location North Greenville Med Campus

Facility 1027 North Greenville Long-Term Acute Care Hospital

Department 10279079 Post-Acute Bed Placement Share your talent with us Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

#J-18808-Ljbffr



  • West Columbia, United States Sephora Full time

    Job ID: 247572 Store Name/ Number: SC-Columbiana (0754) Address: 100 Columbiana Cir, Columbia, SC 29212, United States (US) Hourly/ Salaried: Hourly (Non-Exempt) Full Time/ Part Time: Full Time Position Type: Regular Sales and Services Coordinator At Sales, Coordinator, Service, Beauty Advisor, Customer Experience, Support, Retail


  • West Columbia, United States Sephora Full time

    Job ID: 247572 Store Name/ Number: SC-Columbiana (0754) Address: 100 Columbiana Cir, Columbia, SC 29212, United States (US) Hourly/ Salaried: Hourly (Non-Exempt) Full Time/ Part Time: Full Time Position Type: Regular Sales and Services Coordinator At Sales, Coordinator, Service, Beauty Advisor, Customer Experience, Support, Retail

  • Surgery Coordinator

    1 week ago


    Columbia, United States SCP ENT & Allergy Services, LLC Full time

    The Surgery Coordinator reports to the Front Office and Surgery Coordinator Manager and/or Practice Administrator. The Surgery Coordinator is responsible for completing all scheduling and paperwork for all surgeries, completing all precertification authorizations for surgery, and collecting any pre-surgery payments. This position also includes confirming...


  • Columbia, United States Mid Tennessee Bone and Joint Clinic Full time

    Job Type Full-time Description This position is a full-time, permanent onsite non-clinical position within Tennessee Orthopaedic Alliance in Columbia, TN. Responsibilities: Schedule workers' compensation appointments, follow-up appointments, and coordinate the scheduling of ancillary services Appropriately document and task correspondents from adjuster...


  • West Columbia, United States Ridge Care Full time

    This position is currently available in the following communities: • Friendly, caring disposition with a desire to work with older adults. • Minimum of 1 year experience in coordinating activities for older adults. • Previous Memory Care/Alzheimer’s experience preferred • Must show leadership abilities and work independently, efficiently and...

  • Full Time

    4 days ago


    Columbia, South Carolina, United States Ob Hospitalist Group Full time

    Ob Hospitalist Group is seeking a Board Certified OB/GYN Physician to join the program at:Prisma Health Baptist - Columbia, SC** Sign-on Bonus Available - $$$$ **About the opportunity: As an OBHG hospitalist, you are the in-house expert whose advanced clinical skill and ability to handle any OB emergency dramatically improves patient safety and satisfaction....


  • Columbia, United States Prisma Health Full time

    Inspire health. Serve with compassion. Be the difference. Job Summary Collects specimens from patients and assumes responsibility for the safety and comfort of patients, following established standards and practices. Accessions samples into computer system for accurate testing and billing and obtains signed documents as needed. Reviews outstanding...


  • West Columbia, United States Three Rivers Behavioral Health Full time

    Job Description Responsibilities Full Time Student Nurse Intern Opportunity At Three Rivers Behavioral Health , a bed facility located in West Columbia, SC, we never forget that patients are people -- people with potential, who can have better relationships and live more productive lives. For those who seek a secure environment, healing,...


  • West Columbia, United States University of South Carolina Full time

    The Office of Access, Opportunity and Community Engagement (OAOCE) at the Darla Moore School of Business invites applications for a full-time Engagement Programs Coordinator position. Reporting to the Director for the Office of Access, Opportunity an Coordinator, Engagement, Program, Programmatic, Operations, Administrative, Education, Business Services

  • Program Coordinator

    2 weeks ago


    West Columbia, United States University of South Carolina Full time

    Arnold Childhood Obesity Initiative Research Group is looking for a Program Coordinator who will coordinate and manage day-to-day activities of assigned research projects; supervise, evaluate, and oversee work assignments of staff; assist in developi Program Coordinator, Coordinator, Program, Measurement, Staff, Education, Business Services


  • West Bloomfield, United States KE Camps Full time

    KE Camps is the leading provider of summer camps for country clubs nationwide. We partner with over 230 private clubs all over the country to implement traditional-style day camps for elementary-aged children. Our Staff are the backbone of our programs and therefore, we pride ourselves on giving them an incredible amount of support. As a staff member, we...


  • West Bloomfield, United States KE Camps Full time

    Job DescriptionJob DescriptionKE Camps is the leading provider of summer camps for country clubs nationwide. We partner with over 230 private clubs all over the country to implement traditional-style day camps for elementary-aged children. Our Staff are the backbone of our programs and therefore, we pride ourselves on giving them an incredible amount of...

  • Day Porter

    2 days ago


    West Covina, United States Lot Management Full time

    Job Type Full-time Description About the Job:Full-Time Day Porter Property Address: 2735 E Eastland Center Dr., West Covina, CA 91791 Schedule: Monday - Friday 6:00am - 2:30pm Pay: $17.00/hr Weekly PayAbout LOT Management: Lot Management is a fast-growing maintenance company, specializing in residential, commercial property, and outdoor retail spaces. Lot...


  • West Columbia, United States TargetMarket Inc. Full time

    Social Media CoordinatorJob DescriptionWe are a full-service digital marketing agency located in Charleston, SC. As a leading digital marketing services agency, we bring the process and tools that you might expect from the largest agencies and the specialized skills and knowledge of a boutique together. We specialize in Brand & Web Development, SEO, PPC, SMM...


  • West Hollywood, United States Full Picture Full time

    POSITIONDIRECTOR, PUBLIC RELATIONS – TALENT / ENTERTAINMENT PRLOCATIONLOS ANGELES, CA (Hybrid)THE COMPANYFull Picture is a collective of entrepreneurial-minded, cross-industry experts who dream big, connect the dots in unexpected ways, and consistently deliver legacy-defining initiatives for our clients. Through our four divisions - Consulting, Production,...


  • Columbia, United States Prisma Health Full time

    Inspire health. Serve with compassion. Be the difference. Job Summary Reporting to Materials Management leadership, a Materials Coordinator - Periop is responsbile for full inventory management of perioperative supplies utilizing Pyxis, Workday, and/or Optiflex. They also provide surgical staff with specialty item needs, tracking, reports, and...


  • West Columbia, United States Prisma Health Full time

    Inspire health. Serve with compassion. Be the difference. Job Summary The Senior dispatcher performs daily oversight and work coordination within the Ambulance Services Communications Department. This position is responsible for maintaining operational fluidity and readiness for EMS Dispatch fleet management. This includes, at the direction of - or in...


  • West Columbia, United States CORA Physical Therapy Full time

    As a Patient Services Coordinator at CORA, you’ll be a vital part of our clinic support team by providing meaningful patient interactions and exceptional customer service. You’ll perform a wide range of administrative tasks at the front desk of a dynamic therapy office, and above all, you’ll help create a great first impression and overall patient...


  • West Columbia, United States Ridge Care Full time

    This position is currently available in the following communities: Provide in-service educational opportunities for your team members. Responsible for incident report tracking and intervention implementation. Professional disposition and desire to work with the elderly. Five years’ experience in assisted living or skilled nursing management. Five years...


  • West Columbia, United States Knewin Full time

    Overview Nelson Mullins, an Am Law 100 law firm, is looking for an experienced Events Coordinator to join its dynamic Marketing team in Columbia, South Carolina. A Day in the Life Are you passionate about creating memorable events? Do you thrive in a fast-paced environment? If so, keep reading! This position plays a pivotal role in planning and executing a...