Precertification Representative

cwi; West Allis (WI); On-site; USD 42,000 - 62,000; Full time

Job summary

Children's Wisconsin is seeking a Financial Verification Representative to initiate precertification and authorization for inpatient and outpatient services. You will verify insurance, obtain referrals, and ensure accurate registration information to keep accounts flowing through the billing cycle.

You will work with families, providers, and payers to resolve denials, educate patients about costs, and support financial counseling when needed.

Qualifications

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

Responsibilities

• Initiates precertification and authorizations online, phone or written documentation for all day surgeries, radiology procedures, therapies, psychiatry services, and other outpatient services.
• Contacts insurance companies, primary care physicians, and patient families to secure referrals for patients with out-of-network insurances.
• Enters referral and precertification/prior authorization information into Epic timely and accurately.
• Educates patient/guardian about the managed care process and obtaining valid referrals and authorizations.
• Participates in quality improvement initiatives and department meetings.

Skills

Organizational skills

Analytical skills

Prioritization

Communication skills

HIPAA knowledge

Education

High School diploma or GED/HSED

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.