Team Leader, Pre-Certification

Summary

• Position Summary
  • The Pre-Certification Team Lead is responsible for the coordination and supervision of daily activities for staff members responsible for obtaining/verifying pre-certification for services provided to ensure appropriate reimbursement is obtained. Duties include training, accurate and efficient operations monitoring and reporting to ensure compliance with contractual agreements, federal regulations and hospital policies and to maximize the hospital's cash flow. The Team Leader maintains open communication and works cooperatively with ancillary departments and physician offices.
• Education
  • Associates - Required
• Experience
  • 3-5 Years In a hospital/physician office setting - Required
  • 3-5 Years clinical experience - Preferred
• License & Certification
  • None Required
• Core Job Functions
  • Seeks answers/assistance from the appropriate source. Keeps up to date on billing/compliance rule changes.
  • Manage priorities to provide customized reports and information at various times. Provide support with requests and solutions.
  • Understands the skill needs and capabilities of each staff person and helps design a plan to improve those skills. Develops training materials and opportunities for staff to improve their skills.   
  • Communication with the team is accurate and timely. Regular staff meetings are held. Physicians and staff are supported in daily operations through effective troubleshooting of clinical issues. Patient care needs are given priority in all operational decisions.
  • 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.