Precertification Specialist - Pulmonary

Saint Luke's North Hospital; Kansas City (MO); On-site; USD 42,000 - 60,000; Full time

Job summary

Saint Luke's North Hospital seeks a Precertification Specialist to join its Pulmonary Specialty Team. The role is onsite at our Plaza location, Monday through Friday, 8am–4:30pm, with no nights or weekends.

You will obtain prior authorizations, assist with insurance eligibility, and communicate patient responsibilities for both facility and physician billing. Experience in medical reception, insurance knowledge, and familiarity with Epic are preferred to coordinate with clinicians, payers, and

Qualifications

• Previous medical background and front desk experience preferred.
• Insurance knowledge preferred.
• On-site work at Plaza location.

Responsibilities

• Obtain precertifications and prior authorizations for procedures and surgeries.
• Coordinate with physicians to meet insurance eligibility criteria.
• Update Epic queues with notes, authorization numbers and periods.
• Collaborate with Financial Clearance Center to determine patient responsibility.
• Run Experian reports to obtain physician estimates and coordinate benefits.
• Inform patients about prior authorization and patient responsibility.
• Coordinate scheduling with OR/ASC and vendor reps.

Skills

Medical background

Front desk experience

Insurance knowledge

Tools

Epic

Experian

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.

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)