Pre-certification Coordinator 1

The Ohio State University Wexner Medical Center; Kentucky; On-site; USD 40,000 - 52,000; Full time

Job summary

The Ohio State University Health System seeks a Pre-Certification Coordinator to verify benefits for outpatient, inpatient, and ambulatory services and obtain prior authorization for visits and procedures.

The role involves contacting patients to gather demographic and insurance information, determining predeterminations, and communicating expected co-pays. Strong knowledge of payer requirements and medical terminology is preferred.

Qualifications

• High School diploma or GED.
• 6 months relevant experience in health care setting/revenue cycle or customer service.
• Experience with authorization work in an insurance company, physician practice, or hospital setting.
• Experience with Windows, Excel, and intranet/internet navigation tools and system content.
• Ability to work in multiple databases and software applications; communicate clearly with health care team.

Responsibilities

• Verify benefits for outpatient, inpatient and ambulatory services and obtain prior authorization.
• Coordinate pre-certification and predeterminations for scheduled visits and surgeries.
• Contact patients/families to obtain demographic and insurance information essential to authorization processes.
• Inform patients of co-pays that will be due.

Skills

Customer service

Medical terminology

Authorization work

Education

High School diploma or GED

Tools

Windows

Excel

Job description

Scope of Position

The Ohio State University Health System is committed to improving access and service to customer. The Pre-Certification position functions as an integral member of the health care team to reflect a culture of cooperation, enthusiasm and mutual respect. This position ensures the coordination of the insurance verification and precertification process for all outpatient procedures, inpatient admissions and outpatient surgeries and other designated services for patients to The Ohio State University Health System.

Position Summary

The Pre-Certification coordinator's responsibilities include understanding and verifying benefits for Outpatient, Inpatient and Ambulatory Surgery Services as well as obtaining prior authorization for visits, procedures and hospitalizations, pre-approval, PCP referrals, and predeterminations for all electively scheduled admissions and outpatient surgeries and other designated outpatient visits. In addition, the analyst will at times contact patients/families to determine additional demographic and insurance information essential to the authorization processes while also informing patients of co-pays that will be due.

Minimum Qualifications

High School diploma or GED, and 6 months Relevant Experience in Health Care Setting/Existing, Revenue Cycle Department OR Customer Service Experience OR Experience with authorization work in an insurance company, physician practice, or hospital setting. Experience with medical terminology and payer requirements preferred. Experience with Windows, Excel, and intranet/internet navigation tools as well as system content.Demonstrated ability to work in multiple databases and software applications; experience using automated databases for management and reporting. Ability to work in self-directed manner while interacting with consumers, physicians and all medical center faculty and staff. Ability to communicate clearly with health care team.

FUNCTION: Finance
SUB-FUNCTION: Revenue Cycle Pre-certification
CAREER BAND Individual Contributor - Technical
CAREER LEVEL: 1

Thank you for your interest in working at Ohio State.

Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.

The university is an equal opportunity employer, including veterans and disability.