Precertification Specialist, UofL Health Physicians Outpatient, 9a-5p

UofL Health; Louisville (KY); On-site; USD 42,000 - 54,000; Full time

Job summary

UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, and nearly 200 physician practice locations. The Precertification Specialist ensures timely prior authorizations, medical necessity determinations, and financial clearance for hospital and physician services across clinics and facilities.

With a focus on accurate documentation and efficient workflows, the role requires patient-focused communication, adherence to policies, and ongoing

Qualifications

• High School Diploma or equivalent required.
• At least 1 year of patient access, insurance verification, prior authorization, or related experience.
• Preferred: 3 years of prior authorization or related experience.
• Knowledge of EIPC.
• Medical terminology preferred.

Responsibilities

• Identify necessary clinical documentation to support medical necessity for scheduled procedures/medication orders.
• Submit authorizations and clinical information to payer in a timely fashion per plan rules.
• Assess orders to determine patient class and clarify with physicians as needed.
• Verify eligibility and coverage with insurance plans for procedures and benefits.
• Coordinate patient encounters across multiple systems and applications.
• Document all findings and communications in the patient record.

Skills

Patient access

Insurance verification

Prior authorization

Education

High School Diploma or equivalent

Tools

Electronic Health Record (EHR) systems

Job description

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.

Address

401 E. Chestnut 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

Education

Additional Job Description: 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.