Precertification Specialist - Pulmonary

SLMG Saint Luke's Physician Group, Inc.; Kansas City (MO); On-site; USD 42,000 - 62,000; Full time

Job summary

Saint Luke’s Health System is seeking a Precertification Specialist for our Plaza location. The role supports obtaining prior authorizations for procedures, tests, and surgeries, coordinating with physicians, staff, and payers to determine eligibility and patient responsibility.

The position emphasizes medical background, front desk experience, and insurance knowledge, with a Monday–Friday schedule from 8am to 4:30pm, and no nights or weekends.

Qualifications

• Previous medical background, front desk experience and insurance knowledge preferred.

Responsibilities

• Obtain prior authorizations/pre-certifications for procedures, testing and surgeries as required by payers.
• Collaborate with clinicians, staff and payer representatives to gather and submit information and communicate patient benefits and out-of-pocket costs.
• Obtain precertifications for in-clinic procedures, testing, surgeries and injections; coordinate with physician to ensure eligibility criteria.
• Coordinate with the Financial Clearance Center to communicate patient responsibility for facility billing.
• Run Experian reports to obtain physician billing estimates and coordinate information for physician billing portions.
• Communicate with patients to update on prior authorization and patient responsibility for both facility and physician billing.
• Coordinate with OR/ASC staff to obtain scheduling information and communicate with patients.
• Schedule procedures with vendor representatives as needed.

Job description

Job Description Join our Pulmonary Specialty Team as a Precertification Specialist! Monday - Friday, 8am - 430pm No Nights, No Weekends This position will be located onsite at our Plaza location. Previous medical background, front desk experience and insurance knowledge preferred.

Responsibilities

• 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 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: Less than 1 year

Job Details

• Full Time Day (United States of America)

Saint Luke’s Health System includes 18 hospitals and campuses across the Kansas City region, home care and hospice, behavioral health care, dozens of physician practices, a life care senior living community, and more.

Find out more about what Saint Luke’s offers: http://www.saintlukeskc.org/about-saint-lukes