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Pre-Certification Specialist I-Admitting

Company: Nemours
Location: Pensacola
Posted on: November 23, 2021

Job Description:

This position is responsible for: Demonstrating excellent customer service, obtain and enter authorization and request pre-certifications for assigned clinics. Be very familiar with the requirement of all insurance types. Review, evaluate and verify clinic authorizations for Inpatient, Outpatient, Diagnostic and clinic procedures. Contact insurance companies for pre-certification. Knowledge of different insurance websites for retreiving pre-certifications. Organize and prioritize responsibilities in order to meet deadlines. Show professionalism when interacting with internal and external customers.Essential Functions:

  • Review, evaluate, verify and process assigned clinics authorizations for office visits, pre-certification requests for Inpatient, Outpatient and Clinic procedures for Nemours' patients.
    • Enter all authorization and pre-certification numbers issued into the scheduling system.
      • Contact insurance companies for pre-certification, at least seven days prior to the patient's scheduled procedure.
        • Assist Clinics in obtaining pre-certification for emergency admits and for patients needing same day clinic visit/hospital admit/procedure.
          • Answer and return calls from clinic personnel regarding authorizations pre-certifications.
            • Verify patient eligibility and pre-certification requirements through on-line verification software or by telephone.
              • Maintain open line of communication with clinic personnel.
                • Communicate with assigned clinics regarding unattainable authorizations.
                  • Work-ques: Process encounters via the DAG work-que daily.
                    • Participate and engage in Continuous Improvement events and projects.Requirements:High School Diplomayear of prior experience requiredMust have experience with insurance authorizations and referrals, third party payors, healthcare setting, customer service role

Keywords: Nemours, Pensacola , Pre-Certification Specialist I-Admitting, Other , Pensacola, Florida

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