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Precertification Representative

Macon, GA, United States
Job ID: 16247
Job Family: Patient Accounting/Registration
Status: Part Time
Shift: Day
Shift Details: Regular
Department Name: 52031082941601-Patient Access
Location: 0225


What you will do:

  • Responsible for scheduling, insurance verification, preauthorization request for all scheduled outpatients. 
  • Ensures insurance coverage by telephone, internet resources, or Emdeon.  
  • Resolves any issues with coverage and escalates complicated issues to a supervisor or manager.
  • Reviews all scheduled accounts and completes or ensures all orders and authorizations comply with regulatory requirements and match what is scheduled.
  • Notifies departments if pre-certification requirements are pending to reschedule test.   
  • Responsible for identifying all other payers primary or secondary coverage and obtaining supporting documentation to support reimbursement. 
  • Completes Medical Necessity checks for all Medicare/Medicare replacement plans using correct CPT codes and ICD-10 codes based on provider orders.
  • Creates estimates and notifies patient of financial liability; plans for deposit or upfront collections at time of registration.

What is required:

  • Associate  Degree Required or will substitute two years of relevant experience.  CPAR and/or CHAA certification recommended.
  • Experience in Customer Service, Access, Information Systems or Business Management experience required.