Engage with us for your next career opportunity. Right Here.

Job Type:

Regular

Scheduled Hours:

40

Job Summary:

Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.

The Cancer Care Pre-Cert Specialist is responsible for securing a patient account from the initial interaction through the performed treatment or exam. They are responsible for the verification, authorization, pre collection process and scheduling exams, and pre-registering. This position exists to enhance customer service, while securing accounts according to standard protocols and payer requirements as well as provide patient access to potential coverage options or assistance programs.

Job Description:

• Perform eligibility and benefit analysis for all treatment and exams, i.e., chemotherapy or radiation oncology. 
• Obtain authorization as needed from referring physician office and verify for accuracy.
• Follow individual payer matrix to ensure compliance with daily workflow process.
• Use assigned online eligibility software for payer verification and notification.
• Use TRACE tools as needed.
• Update as needed in registration following all standard registration policies and procedures.
• Verify Medical Necessity is documented
• Completes verification, benefit analysis, and authorization for specified OP procedures/appointments directly with the insurance payer.
• Communicate schedule discrepancies with appropriate department.
• Obtains accurate clinical history for appropriate pre-authorized requests.
• Provide necessary clinical information and pertinent demographic information to insurance company either via web or phone call.
• Requires knowledge of appropriate CPT for each procedure.
• Communicate with referring office or hospital department when a discrepancy arises with procedure scheduled.
• Document appropriate authorization number and valid dates for each procedure.
• Begin work on all pre authorizations scheduled out 30 days.
• Communicates payer requirement changes to the pre access lead or management staff.
• Monitor insurance company protocols for authorization changes.
• Work in conjunction with Marketing and SEP Management to provide resources needed for referring office education.
• Review patient schedule to ensure appropriate pre-certifications are obtained based on medical treatment plan and exams. 
• Follow-up as needed with scheduling conflicts or problems.
• Work with other departments and outside entities to establish a positive working relationship that promotes cooperation and teamwork.
• Communicate with Quality Management on a daily basis to ensure the appropriateness of accounts requiring precertification and follow-up by UM personnel.
• Work closely with the financial counseling unit, including any vendors, in the sharing of account information to minimize potential denials and aid in the financial assistance process.
• Maintain a communication network with physicians offices, internal departments and payers to help obtain needed information and resolve problem accounts.
• Work with PFS and Revenue Cycle departments to complete retro authorization request.
• Provide support and assistance with claims denial due to pre-authorized issues.
• Documents accounts appropriately.
• Adheres to Point of Service Collection policy.
• Uses strong customer service skills that reflect Mission, Vision, and Values statement of the St. Elizabeth HealthCare.      
• Maintains strict patient confidentiality at all times.
• Promotes cooperation and teamwork
• Speaks clearly and concisely in a courteous and friendly tone of voice.
• Listens carefully to the caller, answers questions and seeks assistance from others as needed.
• Interacts with managers, co-workers, and other hospital personnel in the sharing of work-related objectives and the need for clarification and/or process improvement.
• Demonstrates a personal commitment to continuous quality improvement through active participation.

Additional Requirements

• Required to attend monthly staff meetings, possible evening or weekend hours.
• Responsible for completing annual hospital and department educational requirements.
• Attends meetings and webinars as assigned.
• Adhere to policy and procedures of St. Elizabeth HealthCare.
• Performs other duties as assigned.  May schedule and/or pre-register OP procedures/appointments from physicians offices, patients, or other ancillary departments via telephone inquiry, fax request or CPOE WQ.

Education, Credentials, Licenses:

• High School Diploma or GED

Specialized Knowledge: 

• PC skills, including Word and Excel.
• Strong Interpersonal and organization skills.
• Data Entry Skills above 100 Net Key strokes/min.

Kind and Length of Experience: 

• 1 year Health care experience including: registration, scheduling, verification or authorization process, interpreting healthcare insurance plans from commercial, state, and federal payers, clerical experience.

FLSA Status:

Non-Exempt

Right Career. Right Here. If you're looking for the right careers in healthcare, the right place to be is at St. Elizabeth. Join us, and you'll take pride in the level of care we offer our community and dis

Apply Now

Ref. Number
JR301563

Category
Cancer Care

Department
Corporate Edgewood Cancer Center Administration

Shift
1st Shift

Hours
40 hours

Apply Now