Pre-certification Coordinator 1

The Ohio State University Wexner Medical Center; United States; Remote; USD 40,000 - 54,000; Full time

Benefits offered by this job

Medical, dental and vision

Paid time off

Retirement plan

Job summary

The Ohio State University Wexner Medical Center is seeking a Pre-certification Coordinator 1 to coordinate insurance verification and precertification for outpatient and inpatient services, including obtaining prior authorization and predeterminations.

The role involves communicating with patients and care teams, explaining co-pays, and ensuring accurate demographic and insurance information for efficient authorization processes.

Qualifications

• High School diploma or GED
• 6 months relevant experience in health care setting / revenue cycle or customer service
• Experience with medical terminology and payer requirements preferred
• Experience with Windows, Excel, and intranet/internet navigation tools
• Ability to work in multiple databases and software applications
• Ability to communicate clearly with health care team

Responsibilities

• Coordinate insurance verification and precertification processes for outpatient procedures, inpatient admissions, and outpatient surgeries
• Obtain prior authorization, pre-approval, PCP referrals, and predeterminations for elective admissions and surgeries
• Contact patients/families to gather demographic and insurance information for authorization processes
• Inform patients of co-pays and help navigate the authorization process

Job description

Job Title: Pre-certification Coordinator 1 Department: East | Precert and Financial Counseling

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

Additional Information: Location: Remote Position Type: Regular Scheduled Hours: 40 Shift: First Shift

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.

At Ohio State, you'll find work that inspires you. We offer roles and growth opportunities in countless fields and specialties - including a job that's right for you. Ohio State benefits give you options to take care of what matters most to you - and opportunities to make adjustments as your life and needs change, including:

• Medical, dental and vision coverage, with Ohio State paying a significant portion of the cost.
• Paid time off, including sick and vacation time and 11 holidays.
• State retirement plan or an alternative retirement plan, both with generous employer contributions.

As Buckeyes, we accomplish more together. No matter your role, you'll be part of creating what people need now: pathways to education, research and health care. Working at Ohio State means you're part of a team with a strong sense of community and an unwavering commitment to excellence - and, of course, incomparable Buckeye spirit. We bring out the best in people, help each other succeed and learn together. By joining Ohio State, you become part of a top-20 public university with one of America's leading academic health centers. We're a team of dedicated colleagues with access to boundless resources that support you.