Precertification Specialist

Saint Luke's; Kansas City (MO); On-site; USD 42,000 - 54,000; Full time

Job summary

Saint Luke’s ENT is seeking a Precertification Specialist to join our team onsite at the Plaza location in Kansas City, MO. Working Monday–Friday, 8:00 am–4:30 pm, you will obtain precertifications and communicate patient benefits and expected responsibilities. Occasional travel to other ENT locations may be required.

No nights or weekends. You will interact with clinicians, patients, and payer representatives while updating Epic queues and coordinating with the Financial Clearance Center to

Qualifications

• 2 years of applicable experience in precertification or medical scheduling.

Responsibilities

• Obtain precertification/prior authorizations for in-clinic procedures, testing, surgeries, and injections as required by insurance.
• Assist with Hearing Aid Services.
• Assist with front office support.
• Coordinate with physician to confirm patient meets insurance eligibility criteria.
• Update Epic work queues with calls, departments, contacts, and authorization details.
• Collaborate with Financial Clearance Center to communicate benefits and patient responsibility for facility billing.
• Run Experian reports to estimate physician billing amounts and coordinate with Physician CBO for patient responsibility.
• Inform patients about benefits and out-of-pocket costs for both facility and physician billing.
• Coordinate with OR/ASC staff to schedule and communicate with patients.
• Schedule procedures with vendor representatives as needed.

Skills

Patient communication

Front office support

Team collaboration

Medical billing knowledge

Tools

Epic EMR

Experian

Billing software

Job description

Job Description

• Monday - Friday, 8am - 430pm
• This position will be located onsite at our Plaza location with occasional travel to other ENT locations as needed

Job Description

Join our Saint Luke's ENT Team as a Precertification Specialist!

• Monday - Friday, 8am - 430pm
• No Nights, No Weekends
• This position will be located onsite at our Plaza location with occasional travel to other ENT locations as needed

The Precertification Specialist is responsible for obtaining prior authorizations/pre-certifications, as required by third party payers, for procedures, testing and surgeries performed in the department or elsewhere. The position regularly interacts and collaborates with clinicians, technicians, other department staff and payer representatives to gather and submit necessary information, and then communicates with patients regarding their benefits and expected out-of-pocket costs.

• Obtains precertification/prior authorizations for in clinic procedures, testing, surgeries, injections, etc., as required by insurance prior to scheduled date for both facility and physician
• Assists with Hearing Aid Services
• Assists with front office support
• Coordinates with physician to ensure that patient’s condition meets insurance eligibility criteria
• Updates appropriate work queues within Epic, including notes with updates on calls made, departments/people spoke with, prior auth numbers and authorization periods
• Interacts with the Financial Clearance Center Team to coordinate information needed to communicate benefits and patient responsibility for the facility billing portion
• Runs report on Experian to obtain the physician billing estimate and interacts with the Physician CBO to coordinate information needed to communicate benefits and patient responsibility for the physician billing portion
• Communicates regularly with patient to update on prior authorization and to provide patient responsibility estimate for both facility and physician billing sides.
• Interacts with OR and/or ASC staff to obtain scheduling information and to coordinate communication to the patient
• Schedules procedure with vendor rep, as needed

Why Saint Luke’s?

• We believe in work/life balance.
• We are dedicated to innovation and always looking for ways to improve.
• We believe in creating a collaborative environment where all voices are heard.
• We are here for you and will support you in achieving your goals.

Job Requirements

Applicable Experience:

2 years

Job Details

Full Time

Day (United States of America)