Precertification Coordinator

Neurocare, Inc.; Memphis (TN); On-site; USD 40,000 - 60,000; Full time

Job summary

Neurocare, Inc. is seeking a Precertification Coordinator to support sleep study referrals remotely. You will verify payor coverage, coordinate with physicians, and guide patients through the precertification process.

This role emphasizes strong organizational and communication skills, collaboration with clinical staff, and adherence to payor guidelines to ensure timely approvals.

Qualifications

• High school diploma or GED required.
• Bachelor's degree preferred.
• Medical background and knowledge of medical terminology preferable.

Responsibilities

• Identifies payor coverage and verifies precertification status.
• Performs clerical tasks to expedite precertification and documents patient information.
• Collaborates with physicians to document medical necessity and select testing type per payor.
• Coordinates referrals from PCP to the specialist for precertification.
• Provides precertification information to payor and monitors decision outcomes.
• Communicates outcomes to physician and patient.
• Clarifies orders or requests alternative study as approved by payor.
• Updates precertification criteria and payor requirements as needed.
• Ensures data is accurately entered into patient accounts.
• Maintains regular communication with insurers, providers, and customers to verify coverage.
• Documents communications and steps in the patient database.
• Works with team and staff to ensure high-quality service and regulatory compliance.

Skills

Organization

Communication

Time management

Teamwork

Customer service

Computer skills

Critical thinking

Education

High school diploma or GED

Bachelor's degree preferred

Tools

Microsoft Word

Microsoft Access

Job description

Precertification Coordinator

This position is fully remote but candidate must reside in: GA, IL, TN, AZ, NH, MA, CT, FL, or TX.

Why Neurocare?

• Great introduction to Healthcare Administration
• Promotes from within (many of our coordinators have been promoted to other positions within the company)
• Dynamic, professional environment
• Excellent training
• Independent work within a team environment
• Learn about the exciting field of sleep medicine

Neurocare, Inc., is the largest employer of Sleep Technologists in the New England area for over 35 years. We are a patient-centric, quality-focused organization. We collaborate with high profile academic medical centers, community hospitals, and physician groups to design and manage state of the art sleep disorder programs. Our strong commitment to uncompromising quality care and customer service has driven our reputation as a leader in the field.

The Precertification Coordinator works as part of a team with responsibility for providing customer service to a wide range of internal and external customers within a busy clinical setting. Under general direction, coordinates all precertification aspects for sleep study referrals including facilitation of precertification information with the referring physician, educating the patient to the precertification process, working with the patient and physician to identify alternatives when a precertification is denied.

Essential Functions:

• Identifies payor coverage and makes online and/or verbal inquiries to third party payers to verify pre-certification status.
• Performs various clerical tasks to expedite the precertification process, including documentation of patient information, and medical record reproduction to provide supporting medical necessity documentation.
• Work with physicians to ensure optimal documentation of medical necessity and to qualify the patient for the optimal testing type given the patients’ needs, abilities, and functional status, comorbidities, and signs and symptoms of sleep disorders-within the payor guidelines.
• Coordinate referrals from the PCP to the specialist ordering a sleep study, when such referrals are required prior to study precertification.
• Provide precertification information received from the referring physician to the payor, and monitor for decision outcome.
• Communicate outcome to physician and patient.
• Communicate with physicians to clarify orders or request an alternative study as approved by the payor.
• Identify and communicate changes to precertification criteria, requirements, processes as required by payors.
• Verify information obtained is accurately entered into patient account platforms.
• Communicate regularly with customers, insurance companies and healthcare providers to ensure thorough and accurate verification of coverage.
• Enter detailed notes in patient database regarding communication with customer and steps taken in verification process.
• Work closely with other team members, client administrative staff and physicians and physician office staff to ensure highest level of customer service and compliance with regulatory guidelines.

Requirements:

• High school diploma or GED
• Bachelors degree preferred
• Medical background and knowledge of medical terminology preferable

Skills and Competencies:

• Excellent organizations and communication skills.
• Excellent time management skills with meticulous attention to detail.
• Good team and interpersonal skills.
• Ability to multi-task and handle a variety of situations at one time.
• Outstanding customer service skills.
• Computer skills in Word and Access; ability to be trained, understand, and use new software programs.
• Strong critical thinking and problem-solving skills.

Neurocare, Inc. EOE