Job description
Pre-certification Specialist -
Pain Management
Our mission is simple: provide services unparalleled in quality and efficiency while cultivating an environment that emphasizes the individual needs of each of our patients. We understand patients have a choice when it comes to their healthcare. So we combined the most advanced technology, with comprehensive, quality care and the finest patient experience this area has to offer to make that choice easier.
Job Summary:
Works with various insurance companies and referring physician offices to obtain insurance pre-certification for pain management procedures ordered.
Our mission is simple: provide services unparalleled in quality and efficiency while cultivating an environment that emphasizes the individual needs of each of our patients. We understand patients have a choice when it comes to their healthcare. So we combined the most advanced technology, with comprehensive, quality care and the finest patient experience this area has to offer to make that choice easier.
Job Summary:
Works with various insurance companies and referring physician offices to obtain insurance pre-certification for pain management procedures ordered.
- Respond promptly to referral source requests for information, supporting documentation, or other report needs
- Obtain accurate and detailed information to begin investigating sources for payment and gather patient information
- Obtain authorization from payer sources to begin services
- Answer and screen telephone referrals
- Handle incoming calls for department and schedule patients as needed
- Assist in resolving insurance issues, re-authorization and eligibility issues
- Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements
- Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed
- Facilitate follow-up regarding ongoing services, eligibility and authorization
- Communicate payer verification or benefit issues
- Record insurance information to maintain data and communicate insurance information to pertinent staff
- Maintain confidentiality of patient information
- Independently maintain and work from the electronic medical record and additional databases
- Obtain pre-certification number from physician’s office if applicable
- Maintain current list of facility insurance contracts
- Assist in the development, organization, and maintenance of role specific documents, policies, and tools
- Follow all federal, state, and regulatory guidelines to maintain compliance
Requirements:
Required
- Training or courses in business office activities
Preferred
- Insurance verification experience
- Minimum of 2 years’ experience pre-authorizing medical imaging exams across modality and specialty (FP or IM office experience a plus)
Work Site Highlights:
Founded in 1996, Southwoods Health has grown from a physician owned Ambulatory Surgery Center with four operating rooms to a multi-service, physician owned health system. The Surgical Hospital at Southwoods is an acute care hospital renowned for providing a superior patient experience and consistently ranking at the top of national patient satisfaction and quality of care surveys. The hospital continues to expand its scope of services, which includes inpatient, outpatient and robotic-assisted surgery, as well as endoscopy services. Southwoods offers a provider network comprised of hundreds of physicians and advanced practice providers, as well as an expanding array of ancillary health services at locations across Mahoning, Trumbull and Columbiana Counties – all of which are certified to meet Southwoods’ high operational standards. Southwoods Health is an Equal Opportunity Employer.
Full-time. Monday – Friday dayshift.
www.southwoodshealth.com
#SWH2022
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