Precertification Specialist, Nucleus Building, 8:00a-4:30p

University of Louisville Physicians; United States; On-site; USD 42,000 - 62,000; Full time

Job summary

UofL Health is seeking a Precertification Specialist to ensure timely and accurate prior authorization and financial clearance for procedures across clinics and hospitals in Louisville. You will verify patient eligibility, coordinate with physicians, submit authorizations, and maintain precise documentation while upholding HIPAA and departmental policies.

This role requires strong organization, attention to detail, and the ability to work across multiple systems to deliver a positive patient

Qualifications

• Experience with patient access, insurance verification, prior authorization, or related roles.
• Knowledge of medical terminology is preferred.
• Excellent attention to detail and accuracy in documentation.

Responsibilities

• Identify all required clinical documentation to support medical necessity for scheduled procedures.
• Submit authorizations and clinical information to payers in a timely, compliant manner.
• Assess orders to determine patient class and coordinate with physicians for clarification.
• Contact insurance plans to determine eligibility and coverage for procedures.
• Coordinate patient encounters using multiple systems and registration apps.
• Document findings and communications in the patient record.
• Meet productivity standards and ensure accurate referrals.
• Comply with HIPAA and organizational policies.

Skills

Prior authorization

Insurance verification

Patient access

Medical terminology

Education

High School Diploma or equivalent

Tools

Electronic Health Record

Job description

Primary Location: Nucleus Building - ULP - AMG Address: 300 E. Market St. Louisville, KY 40202 Shift: First Shift (United States of America)

Job Description Summary: UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehab Institute and Brown Cancer Center. With more than 12,000 team members-physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals-UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.

The Precertification Specialist sets the precedence to ensure a positive patient experience for upcoming surgical procedures and diagnostic tests by accurately and efficiently completing all necessary steps related to prior authorization, medical necessity determination and financial clearance for the hospital system and physician services for clinics, adult acute facilities and diagnostic centers.

Job Description

Accurately and efficiently identifies all appropriate and necessary clinical documentation to support medical necessity for all scheduled procedures/medication orders for multiple service lines and clinics.

Submits authorizations and clinical information to the appropriate payer/benefit manager in a timely fashion in compliance with plan rules including appropriately utilizing the CMS IP Only list.

Assesses orders to determine appropriate patient class and works with physicians to clarify as necessary Contacts insurance plan/payers to determine eligibility, coverage information for specific procedures and benefit information Coordinates patient encounters using multiple systems applications, various registration applications, clinical operating systems, eligibility verification systems and medical necessity applications.

Documents all findings/communications thoroughly and accurately in the patient record.

Meets or exceeds productivity standards in the completion of daily assignments and accurate production.

Documents all authorization information accurately in the referral as necessary to produce a clean transaction with the payer.

Answer and responds to all communications through multiple applications in a timely and professional manner to ensure a positive patient experience.

Complies with all departmental and organizational policies and procedures.

Complies with local, state, and federal rules and regulations and the requirements of accrediting bodies.

Prioritizes work according to the department, hospital, and patient needs.

Independently works to resolve patient and provider questions related to prior authorizations, referrals, and insurance verification.

Acts as a liaison between the patient, payer, provider and clinical support staff.

Responsible for managing/setting up peer to peers and/or appeals for providers in a timely and professional manner according to individual plan guidelines.

Work with all necessary parties to ensure patients are rescheduled/ notified of denials promptly.

Responsible for understanding and staying current and up to date on payer regulations.

Accurately provide expected timeframes /payer guidelines to patients and providers regarding prior authorization/ financial clearance.

Maintains compliance with all company policies, procedures and standards of conduct Complies with HIPAA privacy and security requirements to maintain confidentiality at all times Performs other duties as assigned

Additional Job Description

Education: High School Diploma or equivalent (required)

Experience: At least one year of patient access, insurance verification, prior authorization, or related experience (required) 3 years of prior authorization or related experience (preferred) Medical Terminology preferred Preferred Qualifications Healthcare experience preferred. Electronic Health Record experience preferred. Knowledge of EIPC.

UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, nearly 200 physician practice locations and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital. With more than 14,000 team members - physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care.