Revenue Cycle Precert Specialist

Position #: 24000C2W
Position: Revenue Cycle Precert Specialist
UH Facility: University Hospitals
Shift: Days
Status: Full-time
Work Days of Week: M-F

City: Cleveland

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From entry to executive level, every position and every professional at University Hospitals has a direct impact on our ability to offer excellent care to our patients, their families and our community.

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JOB DESCRIPTION & QUALIFICATIONS

Description

A Brief Overview

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.

What You Will Do

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.
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

Additional Responsibilities

Performs other duties as assigned.
Complies with all policies and standards.
For specific duties and responsibilities, refer to documentation provided by the department during orientation.
Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Qualifications

Education

High School Equivalent / GED (Required)

Work Experience

1+ years experience in hospital Revenue Cycle/healthcare, working with insurance companies/third-party payers or related experience (Required)
Experience with clinical applications (Preferred)

Knowledge, Skills, & Abilities

Knowledge of managed care insurance requirements is essential. (Required proficiency)
Notable client service, communication and relationship building skills. (Required proficiency)
Ability to function independently and as a team player in a fast-paced environment. (Required proficiency)
Must have strong written and verbal communication skills. (Required proficiency)
Professional demeanor (Required proficiency)
Detail-oriented and organized, with good analytical and problem solving ability (Required proficiency)
Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, multi-line phone, FAX machine, etc.). (Required proficiency)

Physical Demands

Standing Occasionally
Walking Occasionally
Sitting Constantly
Lifting Rarely 20 lbs
Carrying Rarely 20 lbs
Pushing Rarely 20 lbs
Pulling Rarely 20 lbs
Climbing Rarely 20 lbs
Balancing Rarely
Stooping Rarely
Kneeling Rarely
Crouching Rarely
Crawling Rarely
Reaching Rarely
Handling Occasionally
Grasping Occasionally
Feeling Rarely
Talking Constantly
Hearing Constantly
Repetitive Motions Frequently
Eye/Hand/Foot Coordination Frequently

Travel Requirements

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LOCATION

Working at University Hospitals

Careers at University Hospitals offers opportunities to provide care locally in the Cleveland area with the power to impact healthcare nationwide. As a leader in our industry, our staff share a commitment to Be the Difference in the lives of our patients and our communities, from Northeast Ohio and beyond. Take a look at this video to discover how we’re building an organization for the future, today. Note: video content was obtained prior to the COVID-19 pandemic.

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Contact Us

To contact University Hospitals Human Resources department, or to request a reasonable accommodation, please call 216-767-8900 or send us an email at employment@uhhospitals.org

Equal Employment Opportunity Statement

It is the policy of University Hospitals to provide equal opportunity to all of our employees and applicants for employment. Decisions concerning employment, transfers and promotions or other conditions of employment are all made upon the basis of the best qualified candidate without regard to race, color, national origin, age, religion, veteran status, disability, gender, sexual orientation, gender identity, or marital status in accordance with Federal and Ohio law. A qualified individual with a disability will be considered for employment on the same basis as non- disabled applicants if he/she can perform the essential functions of the job sought, with or without a reasonable accommodation, and without imposing a direct threat to the health or safety of others or him/herself. EEO is the Law

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