Precertification Clerk

LMH; Lawrence (KS); On-site; USD 32,000 - 42,000; Full time

Job summary

LMH Health in Lawrence, KS is seeking a Pre-Certification Clerk to coordinate between insurance providers, physician offices and hospital departments to obtain prior authorizations and notify patients of coverage details.

You will verify eligibility, determine benefits, estimate patient responsibility, contact patients, arrange advance payments or payment plans, and ensure early registration with accurate demographics.

Qualifications

• High School diploma or equivalent.
• Two years prior healthcare setting work experience preferred.

Responsibilities

• Coordinate pre-certification with insurance, physicians, registration and billing to obtain prior authorizations.
• Verify insurance coverage and determine benefits for requested services.
• Inform patients of benefits and estimated financial responsibility; initiate payments or payment plans.
• Perform early registration and ensure accurate patient demographics per policy.
• Document communications with insurance companies, offices, scheduling, and billing.

Education

High School diploma or equivalent

Tools

RelayHealth Verifier

STAR

Job description

## Precertification ClerkApply: Lawrence, KS: Full time: Posted Today: JR101154# Something special starts here.You can’t define it, but you know it when you see it: the difference between an average life and the good life. When your cup is full – with joy, purpose and lifelong health – it shows. At LMH Health, we are all about healthy people, healthy communities and healthy futures, and that makes us your destination for an exceptional career. From flexible, work-life harmony to competitive pay and great advancement potential, find everything you’re looking for at LMH Health.You'll find everything you’re looking for at LMH Health:* Join a team that cares about the community* Tuition reimbursement to support continuing education* Professional development and recognition* Excellent benefits**We’re looking for you.**# Job Description**Work Schedule: Mon - Fri 8:00a - 4:30p****I. JOB SUMMARY** 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. **II. ESSENTIAL JOB 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 **III. JOB QUALIFICATIONS** ***Required**** High School diploma or equivalent**Preferred*** Two years prior healthcare setting work experience