Pre Certification Specialist

Department:

37300 Advocate Illinois Masonic Medical Center - Administration: Cancer

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Major Responsibilities:

• To perform all activities related to third-party payer pre-certification requirements to meet the daily pre-certification functions at Dreyer Medical Clinic.
  • 9)Completes pre-certification process or transfers call as appropriate.
  • 10)Upon completion of the pre-certification process, enters authorization number in the order and closes encounter.
  • 8)Monitors all Peer-to-Peer pre-certification decisions forwarded by RN Nurse Specialist and closes case with appropriate determination from pre-certifcation vendor.
  • 1)Verifies per insurance type and service requested the need for pre-certification. Notifies the Business Office when patients with No Insurance or Termed Insurance are identified.
  • 2)Reviews pended order for completeness and accurate coding.
  • 3)Contacts the pre-certification vendor and provides the facility and patient demographic information.
  • 4)Monitor future orders and assure completion of pre-certification process by due date of procedure.
  • 5)Identifies orders placed outside the number of days determined valid by the pre-certification vendor and postpones those orders in EPIC using postpone function or staff message function.
  • 6)Serves as an advocate and liaison between patients, associates, physicians and external customers by sharing necessary information to ensure continuity of care.
  • 7)Completes all patient documentation within the defined time frame and cnsistently completes pre-certification with all appropriate information
• To serve as a resource to Clinic Associates on Pre-certification specific issues
  • 1)Provide technical support to associates, seaders and providers
  • 2)Orient new associates to pre-certification functions in EPIC and other vendor specific applications
  • 3)Provide education to associates, leaders and providers on Dreyer Medical Clinic pre-certifications procedures and protocols
  • 4)Actively participates in special programs and activities designed to address needs of high-end advanced imaging pre-certification processes and acts as resource for the Clinic
• Appointment Scheduling
  • 1)Make outgoing calls to patients to return to the clinic for additional views, confirm appointments and preparations and reschedule no showed and canceled appointments.
  • 2)Execute patient scheduling duties and document within the EPIC/IDX system(s) following provider specifics and scheduling guidelines.
  • 3)Collect necessary information from patient when scheduling and/or cancelling appointments and documents/updates information in EPIC/IDX system(s).
  • 4)Instruct patients on necessary preparations when booking appointments/testing using appropriate language to patient's level of understanding guided by department protocols or technologist/provider/nurse instructions.
  • 5)All communications with callers, internal and external, are conducted in accordance with department protocol, utilizing clinic scripting where indicated.
  • 6)Schedules future appointments in multiple modalities and locations for Radiology both automatically and manually.
• Telephone Communication
  • 2)Answers the telephone promptly within 3 rings.
  • 3)Utilizes outlined departmental and clinic scripting/key words.
  • 4)Restates information to ensure clarity and accuracy.
  • 5)Transfers calls when appropriate, staying on the line and announcing where and why call was transferred. Exceptions to announcing the call would include when transferring to an ACD agent.
  • 1)Timley, complete and accurate communication with internal and external customers
• Other Duties as assigned
  • 2)Attend department meetings and clinic training.
  • 3)Maintain tracking of pre-certification activities as assigned.
  • 4)All required clinic education via ALEX.
  • 5)Other duties as assigned.
  • 1)Special projects as assigned by direct supervisor.

Education/Experience Required:

• - High school diploma or GED -2 years experience in a medical office setting performing related duties/functions.

Knowledge, Skills & Abilities Required:

• - Professional communication and interpersonal skills. - CRT/PC experience in a customer service setting. - Ability to type with good accuracy. - Familiar with MS Word, Excel, and Outlook. - Ability to solve problems posed by callers seeking pre-certification authorizations - Proven ability to handle difficult callers, customers and/or patients. - Knowledge of medical terminology and ICD-9, HCPCS, CPT coding.
• N/A

Physicial Requirements and Working Conditions:

• - Must be able to successfully complete clinic-based training for all associates. - Ability to work with all levels of personnel. - Ability to work under stressful situations. - Frequent periods of extended sitting.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Advocate Aurora Health is one of the 10th largest not-for-profit, integrated health systems in the U.S. with nearly 3 million patients served at more than 500 sites of care in Illinois and Wisconsin, including 28 hospitals. We're redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in a variety of specialties. Advocate Aurora Health is one of the 10th largest not-for-profit, integrated health systems in the U.S. with nearly 3 million patients served at more than 500 sites of care in Illinois and Wisconsin, including 28 hospitals. We're redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in a variety of specialties.