Precertification Specialist

CommuniCare Health Services; Morgantown (WV); On-site; USD 40,000 - 70,000; Full time

Job summary

An established industry player in post-acute care is seeking a dedicated Pre-certification Specialist to enhance its Case Management Department. This full-time role involves supporting the admissions process, ensuring patient satisfaction through effective communication with Managed Care providers. You will thrive in a fun, team-oriented environment while enjoying competitive wages and a comprehensive benefits package. If you have a passion for delivering exceptional service and possess the required experience, this opportunity is perfect for you to make a meaningful impact in the healthcare sector.

Benefits

Competitive wages

PTO plans

Medical coverage

Dental coverage

Vision coverage

401(k) with employer match

Flexible Spending Accounts

Qualifications

• Experience in admissions and managed care precertification is preferred.
• Knowledge of Medicaid, Medicare, and skilled nursing procedures is a plus.

Responsibilities

• Perform pre-certification processes for admissions.
• Maintain relationships with Managed Care providers for patient satisfaction.
• Organize clinical records for submission to managed care organizations.

Skills

Admissions Experience

Managed Care Precertification

Knowledge of Medicaid and Medicare

Customer Service Skills

Organizational Skills

Communication Skills

Basic Computer Skills

Education

Nursing License (preferred)

Job description

Do you have previous Admissions experience with Managed Care?

Due to continued growth,CommuniCare Health Servicesis currently seeking the right professional to fill the full time position ofPre-certification Specialistfor its Case Management Department.
This is a salaried position.

PURPOSE/BELIEF STATEMENT

ThePre-certificationSpecialistassists in developing census and providing external and internal support throughout the admissions process.Previous experience in skilled nursing and/or managed care industry is preferred.This position must work flexible hours. This is not a sales position and the workplace is in an office setting - not in a nursing home.

BENEFITS

The Pre-certification Specialist is a full time, salaried position in a fun, team environment! At CommuniCare, you will enjoy competitive wages, commensurate with experience, and PTO plans. We offer you a menu of benefit options from life and disability plans to medical, dental and vision coverage, from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts.

If you meet the requirements for Pre-certification Specialist, and you would like to be part of a World Class team of professionals,respond to this ad with your resume and salary history for confidential consideration.

POSITION REQUIREMENTS

• Previous Admission Experience and Managed Care Precertification experience is preferred.
• Nursing license preferred but not required.
• Knowledge of Medicaid, Medicare, and Managed Care procedures, as well as laws, regulations, and guidelines that pertain to skilled nursing is preferred.
• Knowledge of Corporate Business Management
• This position must work flexible hours
• Ability to work independently and as a team
• Superior customer service skills, including the ability to resolve conflict
• Good organization skills
• Ability to communicate effectively verbally and in writing
• Must be respectful and a team player
• Must maintain a professional appearance and demeanor
• Must maintain a high level of confidentiality in all aspects of the job
• Must be able to deal tactfully with team members, other staff, residents, and family members, visitors, government agencies, and the general public.
• Must have the ability to make independent decisions when circumstances warrant such action.
• Must be skilled at multitasking and have a sense of urgency to perform time sensitive processes.
• Must possess basic computer skills.

JOB DUTIES AND RESPONSIBILITIES

• Perform all pre-certification processes for Admission.
• Establish and maintain a positive and professional relationship with current and potential Managed Care providers and work to ensure patient and provider satisfaction.
• Communicate with Interdisciplinary team daily to process managed care referrals for precertification approval.
• Organize and maintain documentation of clinical records for submission to managed care organizations.
• Maintain up-to-date financial knowledge of skilled operations, managed care contracts and provide accurate documentation of all services in order to assure accurate reimbursement from all payor sources.
• Demonstrate excellent communications, negotiation, and public relations skills.
• Demonstrate autonomy, organization, assertiveness, flexibility, and cooperation in performing job responsibilities.

About Us

A family-owned company, we have grown to become one of the nation’s largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH). Since 1984, we have provided superior, comprehensive management services for the development and management of adult living communities. We have a single job description at CommuniCare, to reach out with our hearts and touch the hearts of others. Through this effort we create Caring Communities where staff, residents, clients, and family members care for and about one another.