Insurance Precert Representative M-F 830-5

Monday- Friday 830a-5p

WOOSTER COMMUNITY HOSPITAL JOB DESCRIPTION

Insurance Precert Representative

MAIN FUNCTION:

Protects hospital payments for inpatient admissions and outpatient services requiring precertification. Ensures all scheduled outpatient services requiring prior authorization/precertification have the correct and appropriate authorizations prior to services being rendered.

RESPONSIBLE TO: The Director and Manager of Patient Access

MUST HAVE REQUIREMENTS:

Experience working in a physician’s office or hospital setting with third party payers to obtain authorization for hospital services

Proficient in medical terminology

Strong organizational skills and demonstrated ability to work independently.

Current computer or Meditech skills

Demonstrated effective interpersonal and oral communications skills

No written disciplinary action within the last 12 months.

Ability to utilize internet and other technology

PREFERRED ATTRIBUTES:

2 years previous experience in a physician office or hospital setting

Post High School education in medical office skills

POSITION EXPECTATIONS:

* Receives notification of services/testing scheduled to be performed at the hospital

* Effectively navigates payer websites to verify insurance benefits and obtain necessary pre-certs per payer guidelines

* Verifies completion of all needed pre-certs for outpatient procedures

* Maintains a professional relationship with the physician’s and their office staff

* Communicates effectively with other departments all information necessary to complete the precertification process

* Functions successfully in a team-oriented work environment