Pre-Certification Supervisor
- Savannah, GA
- System - Insurance/Payment Verification
- Full Time - Days
- Req #: 3513-12059
Summary
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Position Summary
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Responsible for the implementation and monitoring of ongoing quality, productivity, and efficiency by supervising co-workers within the designated area of pre-certification within the Pre-Visit Services Department. Pre-Certification Supervisor will work with Patient Accounts, Denials Management, and Radiology leaders regarding process flow improvements to deliver a seamless billing experience. Ensures compliance with CMS inpatient guidelines regarding patient status. Maintain working knowledge of payer requirements, ICD-10 and CPT codes. Complete and maintain co-worker schedules making changes according to the needs of the business and patient flow, volumes, and financial status. Pre-Certification Supervisor will work with manager to set and achieve department goals. Align new co-workers with schedule for training, and ensure for appropriate follow-up procedures are in place for co-worker education. Assist in co-worker attendance, tardy, and vacation in compliance with corporate attendance policy. Pre-Certification Supervisor will collaborate with the manager during the new hire process, evaluating performance, and administering employee corrective action. Participate in system upgrades and enhancements.
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Education
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Bachelors of Business - Preferred
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CPT and ICD-10 code knowledge - Required
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Experience
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3-5 Years Pre-certification, insurance verification, patient billing experience in a health care environment. - Required
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1-2 Years Supervisory experience in a health care environment. - Preferred
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Knowledge of regulatory and third party payer requirements to ensure compliance - Required
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License & Certification
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None Required
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Core Job Functions
- Resolves technical and personal issues timely. Promotes cooperation and team work. Monitors co-workers activity to ensure production standards are met daily.
- Provide oversight for Precertification to assure processes are consistent. Monitor denials of outpatient procedures and works closely with the payment resolution department to offer assistance with appeals. Monitor regulatory agencies for current rules and regulations.
- Review EMR schedule for patients that need authorization for their visit or treatment. Review data provided in the electronic eligibility system and resolve errors. Review and work with the operation assistant and other team member to ensure authorization for orders for outside service are obtain when necessary.
- Reviews quality and quantity activity using available reporting tools. Initiates appropriate co-worker counseling and re-training when necessary. Provides ongoing technical training.
- Assess training needs and to provide training to all co-workers, as needed. Maintains all co-workers training records up to date.
- Complete evaluations on time, maintain retention, meet or exceed unit established nationally certified certification, and reach annual assessments according to standards.
- Reviews and approves/denies all co-worker PTO requests. Maintains adequate staffing levels in all areas. Maintains open communication with co-workers regarding call-ins.
