Precertification Representative

Children's Wisconsin; West Allis (WI); On-site; USD 42,000 - 62,000; Full time

Job summary

Children's Wisconsin in Milwaukee is seeking a Financial Verification Representative to support precertification and insurance verification across inpatient and outpatient services. You will pre-register patients and ensure accurate demographic data, helping the billing cycle stay clean.

You will communicate with insurers, providers, and families, enter data into Epic, and assist with referrals and consent where required.

Qualifications

• 2+ years of experience in registration, scheduling or administrative support in a healthcare setting or business environment.
• Experience with insurance referrals and prior authorization is a plus.
• Familiarity with Epic or similar healthcare software is preferred.

Responsibilities

• Initiates precertification and authorizations online, by phone, or written documentation for services as required by payer rules.
• Pre-registers patients and ensures complete demographic information to keep accounts current.
• Verifies insurance details and supports the financial clearance process with counselors when needed.
• Enters referrals, precertification, and authorization data into Epic accurately and timely.

Skills

Financial Verification

Healthcare Billing

Customer Service

Registration

Education

High School diploma or GED

Tools

Epic

Job description

At Children's Wisconsin, we believe kids deserve the best. Children's Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country. We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day,

Job Description

Job Summary

Initiates contact with insurance, third-party billers, physicians and patients/families to obtain precertification and authorization for all inpatient and outpatient services. Pre-registers patients as needed bay calling patient families or by using department protocol. Ensures that al patient accounts flow through the billing cycle without errors caused by lack of authorization/precertification, insurance verification, or incomplete or inaccurate demographic information or other registration-related error which may cause the receivable to remain unpaid or written-off.

Essential Functions

Initiates precertification and authorizations online, phone or written documentation for all day surgeries, radiology procedures, therapies, psychiatry services, and other outpatient services as defined by payer specific requirements Contacts insurance companies, primary care physicians, and patient families to secure referrals for patient that have out of network insurances. Enters referral, and precertification/prior authorization information into Epic both timely and accurately. Proficient in Financial Verification Representative essential functions Completes Ambulatory Clinic deemed/communication tool according to appropriate clinic protocol. Identifies the need for signature required for consent for treatment and financial agreement to pay. Identifies referrals to financial counselors based on CHW administrative guidelines and adheres to the Financial Clearance self-pay process as appropriate. Helps educate patient/guardian/parent about the managed care process and means of obtaining valid referrals and authorizations Participates in quality improvement initiatives, training sessions, and department meetings. Adheres to all CHW and Patient Access policy, procedures and standards. Ensures confidentiality to our customers by creating and maintaining a secure environment in compliance with HIPAA. Utilizes Language Interpretation phone system for non-English speaking patients and families Manages assigned work queues to ensure accuracy and completion per department guidelines and performs other duties as assigned.

Education

High School graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED)

Required Experience

2+ years of experience in registration, scheduling or administrative support experience in a healthcare setting or a business environment. Required 1+ years experience as a Financial Verification Rep preferred. Preferred Experience with insurance referral and authorization processing required in lieu of Verification Rep experience. Preferred Epic experience preferred. Preferred Prior experience working in Windows environment.

Preferred Knowledge, Skills and Abilities

Excellent organizational, analytical, and prioritizing skills necessary to work in a fast-paced environment with multiple tasks done simultaneously. Excellent communication and interpersonal skills necessary to gather and share information with families, and team members in a courteous, professional and confidential manner. Ability to maintain positive communication skills during stressful situations. Analytical ability to determine the anticipated patient liability and ascertain need for financial counseling.

Required for All Jobs

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that may be requested in the performance of this job. Employment is at-will. This document does not create an employment contract, implied or otherwise.

Children's Wisconsin is an equal opportunity / affirmative action employer.

We are committed to creating a diverse and inclusive environment for all employees.

We treat everyone with dignity, respect, and fairness.

We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.

Certifications/Licenses

Dedicated solely to the health and well-being of children We are the region's only independent healthcare system dedicated solely to the health and well-being of children. In Milwaukee and throughout the state, we provide kids and their families a wide range of care and support - everything from routine care for ear aches or sore throats to life saving advances and treatment options. Our academic partner, The Medical College of Wisconsin, brings many of the nation's most well-respected doctors to our team. Together we work to ensure that every child and family we serve receives nothing but the best. Learn more about our affiliation with the Medical College of Wisconsin and the power of academic medicine.