Remote work opportunity available within the state of Ohio! 

As an essential member of the Revenue Cycle team, Pre-cert Specialists ensure authorizations for outpatient testing, ambulatory and inpatient services are obtained before services are rendered.  The successful completion of tasks performed by this position, directly impacts denials and reimbursement from third party payers.  Pre-cert Specialists are skilled in patient/physician relations, registration, scheduling, and precertification. Duties include but are not limited to the following:

• Verifies and pre-certifies inpatient and outpatient services to ensure appropriate  reimbursement from third party payers, government payers and state agencies
• Mastery of skills relating to insurance coverage, benefits, rules & regulations and allocation of plans accurate information and fulfillment of requirements resulting in expected payment for services
• Verifies and allocates insurance plans utilizing electronic eligibility tools, phone calls payer, accesses web portals and initiates appropriate action for services including non-covered and out-of-network insurance services
• Submits timely electronic and verbal notifications and clinical documentation in accordance with contractual requirements and payer guidelines; coordinates with operations and clinical counterparts to obtain and submit necessary information and documentation
• Communicates potential issues and follows GM-98, Service with Authorization guidelines to notify providers of pending authorizations/denials and peer to peer requests; escalates encounters per policy
• Effectively communicates utilizing telephone, emails, or correspondence for internal and external customers; understand when and how to escalate cases that require operations and leadership attention to initiate appropriate action
• Maintains up-to-date knowledge of computer applications, insurance/government regulations, managed care guidelines and Revenue Cycle policies/procedures used within the department. 
• Performs all other duties as assigned by department leadership
• Scans and retrieves appropriate related documents in scanning applications
• Attends and participates in corporate and local team meetings and maintains patient / physician confidentiality.
• Ensures compliance with department productivity and quality standards
• Maintains up-to-date knowledge of computer applications, insurance/government regulations, managed care guidelines and Revenue Cycle policies/procedures used within the department. 
• Performs all other duties as assigned by department leadership
• Scans and retrieves appropriate related documents in scanning applications
• Attends and participates in corporate and local team meetings and maintains patient / physician confidentiality.
• Ensures compliance with department productivity and quality standards

Remote work opportunity available within the state of Ohio! 

As an essential member of the Revenue Cycle team, Pre-cert Specialists ensure authorizations for outpatient testing, ambulatory and inpatient services are obtained before services are rendered.  The successful completion of tasks performed by this position, directly impacts denials and reimbursement from third party payers.  Pre-cert Specialists are skilled in patient/physician relations, registration, scheduling, and precertification. Duties include but are not limited to the following:

• Verifies and pre-certifies inpatient and outpatient services to ensure appropriate  reimbursement from third party payers, government payers and state agencies
• Mastery of skills relating to insurance coverage, benefits, rules & regulations and allocation of plans accurate information and fulfillment of requirements resulting in expected payment for services
• Verifies and allocates insurance plans utilizing electronic eligibility tools, phone calls payer, accesses web portals and initiates appropriate action for services including non-covered and out-of-network insurance services
• Submits timely electronic and verbal notifications and clinical documentation in accordance with contractual requirements and payer guidelines; coordinates with operations and clinical counterparts to obtain and submit necessary information and documentation
• Communicates potential issues and follows GM-98, Service with Authorization guidelines to notify providers of pending authorizations/denials and peer to peer requests; escalates encounters per policy
• Effectively communicates utilizing telephone, emails, or correspondence for internal and external customers; understand when and how to escalate cases that require operations and leadership attention to initiate appropriate action
• Maintains up-to-date knowledge of computer applications, insurance/government regulations, managed care guidelines and Revenue Cycle policies/procedures used within the department. 
• Performs all other duties as assigned by department leadership
• Scans and retrieves appropriate related documents in scanning applications
• Attends and participates in corporate and local team meetings and maintains patient / physician confidentiality.
• Ensures compliance with department productivity and quality standards
• Maintains up-to-date knowledge of computer applications, insurance/government regulations, managed care guidelines and Revenue Cycle policies/procedures used within the department. 
• Performs all other duties as assigned by department leadership
• Scans and retrieves appropriate related documents in scanning applications
• Attends and participates in corporate and local team meetings and maintains patient / physician confidentiality.
• Ensures compliance with department productivity and quality standards

• 1+ years’ experience in hospital Revenue Cycle/healthcare, working with insurance companies/third-party payers or related experience, required. 
• High school diploma or GED required.
• Knowledge of managed care insurance requirements is essential.   
• Notable client service, communication and relationship building skills required. 
• Ability to function independently and as a team player in a fast-paced environment required. 
• Must have strong written and verbal communication skills. 
• Professional demeanor required.
• Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, multi-line phone, FAX machine, etc.) required.
• Must be detail-oriented and organized, with good analytical and problem solving ability
• Experience with clinical applications preferred.