Precertification Clerk

LMH Health•Lawrence, KS

About The Position

The Pre-Certification Clerk is responsible for the effective and efficient coordination between insurance companies, physician offices, registration clerks, scheduling departments, patients, and billing office, regarding pre-certification and notification of services as required by the patient’s medical coverage plan. The Pre-Certification Clerk verifies insurance eligibility, determines benefits, and estimates patient financial responsibility based on the procedure, insurance contracted rate, coverage and benefits. The Pre-Certification Clerk contacts the patient to inform of benefits, initiates payment in advance or payment arrangements, and completes early registration.

Requirements

High School diploma or equivalent

Nice To Haves

Two years prior healthcare setting work experience

Responsibilities

Reviews schedule of services and add-on services making use of appropriate methods to ensure prior authorizations for all diagnostic studies, procedures, surgeries, and testing as required by each insurance company including Workers Compensation has been obtained.
Researches the system for the correct patient’s record and creates a new account for the scheduled service whereby information on authorization requirements and status, insurance eligibility, point of service collection, and billing is entered.
Investigates the physician order, the scheduled procedure, and the authorized service, if required by the payer, to ensure consistency for accurate authorization determination and estimated patient responsibility based upon the contracted rate for the specific procedure or procedures.
Verifies insurance coverage is active through RelayHealth Verifier, insurance websites, or a phone call to the insurance company and updates patient specific insurance information as necessary in STAR.
Contacts the patient by phone to inform of authorization status, if required, review benefit levels and estimated patient financial responsibility, initiates payment in advance or payment arrangements, and transfers the call to the appropriate department if the patient wants to reschedule or talk with a financial counselor.
Performs early registration correcting patient demographics as required by Admission’s department policies.
Documents concisely and accurately all communication with insurance companies, ordering physicians, registration staff, ancillary departments, and the patient related to the scheduled service.
Maintains a working knowledge of coverage policies, pre-certification and benefits for insurance companies and specific employers, procedure codes, contract reimbursement rates, and computer applications.
Follows task specific methods to make certain the best outcome is reached for point of service registration, overall patient experience, and billing.
Acts as a department liaison with physician office personnel, scheduling personnel, patients, insurance representatives, and hospital billing office.
Performs at a high level with little supervision.
Demonstrates excellent inter-personal skills, strong attention to detail, multi-task oriented.
Performs other duties as assigned.
Regular and reliable attendance is an essential function of this position