Pre-Certification Specialist

Summary

• Position Summary
  • Performs required Precertification activities to ensure reimbursement for outpatient services at St. Joseph's/Candler. Ensures timely, accurate and complete documentation of clinical information which supports healthcare services provided to patients.
• Education
  • Associate Degree in Nursing - Required
  • Bachelors in Nursing - Preferred
• Experience
  • 3-5 Years Clinical - Preferred
• License & Certification
  • Nursing License with State of Practice - Required
• Core Job Functions
  • Provide clinical information to third party commercial payers. Documents precert number with appropriate authorization code for payers to ensure appropriate reimbursement. Review EE notes to determine action taken by verification department, financial counselors and patient account representatives and determines additional follow up.
  • Review updated information from payers, Monitor web portal alerts from payer. Maintains updated files on specific payer requirements.
  • Monitor various reports for precertification need. Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
  • Determines if authorization is required. Accurately documents account information.