Precertification Specialist

Position Summary: Responsible for obtaining pre-certifications and pre-authorizations for hospital service lines per assigned caseload by successfully completing the required authorization process in addition to effectively communicating details to appropriate departments. Position Responsibilities: Clinical / Technical Skills (40% of performance review) * Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations. * Request, track and obtain pre-authorization from insurance carriers within time allotted for assigned workload and follow up on regularly pending cases. * Ensure tracking programs and patient records are kept up to date through the pre-certification process. * Demonstrate and apply knowledge of medical terminology, high proficiency of general inpatient hospital understanding including HIPAA regulations. * Clearly document all communication and contacts with providers and personnel in standardized documentation requirements. * Communicate any insurance changes or trends among team. * Prioritize authorization requests according to urgency. * Answer insurance telephone inquiries pertaining to patient accounts. * Perform other duties as required. Safety (15% of performance review) * Strives to create a safe, healing environment for patients and family members * Follows all safety rules while on the job. * Reports "near misses", as well as errors and accidents promptly. * Corrects minor safety hazards. * Communicates with peers and management regarding any hazards identified in the workplace. * Attends all required safety programs and understands responsibilities related to general, department, and job specific safety. * Participates in quality projects, as assigned, and supports quality initiatives. * Supports and maintains a culture of safety and quality. Teamwork (15% of performance review) * Works well with others in a spirit of teamwork and cooperation. * Responds willingly to colleagues and serves as an active part of the hospital team. * Builds collaborative relationships with patients, families, staff, and physicians. * The ability to retrieve, communicate, and present data and information both verbally and in writing as required * Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word. * Demonstrates adequate skills in all forms of communication. * Adheres to the Standards of Behavior Integrity (15% of performance review) * Strives to always do the right thing for the patient, coworkers, and the hospital * Adheres to established standards, policies, procedures, protocols, and laws. * Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence. * Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources. * Completes required trainings within defined time periods, as established by job description, policies, or hospital leadership * Exemplifies professionalism through good attendance and positive attitude, at all times. * Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws. * Ensures proper documentation in all position activities, following federal and state guidelines. Compassion (15% of performance review) * Demonstrates accountability for ensuring the highest quality patient care for patients. * Willingness to be accepting of those in need, and to extend a helping hand * Desire to go above and beyond for others * Understanding and accepting of cultural diversity and differences

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