PRECERTIFICATION SPECIALIST at Cardiovascular Consultants of Kansas, PA in Wichita, Kansas

Job Description:

JOB TITLE: Precertification Specialist

General Summary of Duties: Responsible for reviewing and monitoring schedules to verify what services need to be pre-certified and obtaining precertification as required for procedures or testing.  

Supervision Received:  Clinical Administrator

Supervision Exercised:  None

 

Essential Functions:

1.  Patient health data retrieve as necessary
2.  Collect and record appropriate data in order to issue authorization and route request for services that require medical review to appropriate team member
3. Assess and investigate requests for medical service authorization and authorize select services that do not require clinical judgment
4. Review physicians’ and facility schedules to determine which patients require precertification’s.
5. Maintains strict confidentiality related to medical records and other data.
6. Participates in professional development efforts to ensure currency in health care practices and trends.

Education:

High school diploma

Experience:  Minimum of one year in a clinical setting, minimum of 1-year customer service experience. 

Requirement’s:  None

Knowledge:

1. Knowledge of clinic policies and procedures
2. Knowledge of ICD-10 and CPT codes
3. Knowledge of 
4. Knowledge of computer programs and applications
5. Knowledge of Electronic Health Records
6. Knowledge of customer service concepts

Skills:

1. Skill in gathering, interpreting and reporting insurance information
2. Skill in written and verbal communication
3. Skill in time management and organization

 

Abilities:

1. Ability to sort and file insurance forms and associated information
2. Ability to work effectively with patients, employees and the public
3. Ability to work in a team setting

 

Environmental/Working Conditions:

Normal office environment.  May view computer screens for long periods of time

Physical/Mental Demands:

Requires hand dexterity for office machine operation, stooping and bending to retrieve files and supplies, mobility to complete errands or sitting for extended periods of time.

 

This description is intended to provide only basic guidelines for meeting job requirements.  Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.  

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