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

UofL Health; Louisville (KY); On-site; USD 36,000 - 60,000; Full time

Job summary

UofL Health is seeking a Precertification Specialist to support prior authorization, medical necessity determinations, and financial clearance across clinics and hospital services in Louisville. The role requires identifying medical documentation, submitting authorizations to payers, verifying eligibility, and maintaining accurate patient records to ensure a smooth patient experience.

With a background in patient access or insurance verification and knowledge of medical terminology, you will

Qualifications

• At least one year of patient access, insurance verification, prior authorization, or related experience.
• Three years of prior authorization or related experience preferred.
• Medical Terminology knowledge is preferred.

Responsibilities

• Identify clinical documentation to support medical necessity for procedures and orders.
• Submit authorizations and clinical information to payers in a timely manner.
• Assess orders to determine patient class and clarify with physicians.
• Coordinate patient verifications using registration and eligibility systems.
• Maintain accurate documentation in patient records and referrals.
• Respond to payer inquiries and ensure compliant, timely processing.

Education

High School Diploma or equivalent

Job description

Primary Location:

UofL Phys Outpatient - ULP - AMG

Address:

401 E. Chestnut StLouisville, 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 teammembers—physicians, surgeons, nurses, pharmacists and other highly skilled health careprofessionals—UofL Health is focused on one mission: deliveringpatient-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.