UofL Health
Precertification Specialist, UofL Outpatient Center, Days
UofL Health, Louisville, Kentucky, us, 40201
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Precertification Specialist, UofL Outpatient Center, Days
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UofL Health 1 day ago Be among the first 25 applicants Join to apply for the
Precertification Specialist, UofL Outpatient Center, Days
role at
UofL Health Get AI-powered advice on this job and more exclusive features. Address
401 E. Chestnut St. Louisville, KY 40202 Address
401 E. Chestnut St. Louisville, KY 40202
Shift
First Shift (United States of America)
Job Description Summary
UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehab Institute and Brown Cancer Center.
With more than 12,000 team membersphysicians, surgeons, nurses, pharmacists and other highly skilled health care professionalsUofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.
The Precertification Specialist sets the precedence to ensure a positive patient experience for upcoming surgical procedures and diagnostic tests by accurately and efficiently completing all necessary steps related to prior authorization, medical necessity determination and financial clearance for the hospital system and physician services for clinics, adult acute facilities and diagnostic centers.
Job Description
Accurately and efficiently identifies all appropriate and necessary clinical documentation to support medical necessity for all scheduled procedures/medication orders for multiple service lines and clinics.
Submits authorizations and clinical information to the appropriate payer/benefit manager in a timely fashion in compliance with plan rules including appropriately utilizing the CMS IP Only list.
Assesses orders to determine appropriate patient class and works with physicians to clarify as necessary
Contacts insurance plan/payers to determine eligibility, coverage information for specific procedures and benefit information
Coordinates patient encounters using multiple systems applications, various registration applications, clinical operating systems, eligibility verification systems and medical necessity applications.
Documents all findings/communications thoroughly and accurately in the patient record.
Meets or exceeds productivity standards in the completion of daily assignments and accurate production.
Documents all authorization information accurately in the referral as necessary to produce a clean transaction with the payer.
Answer and responds to all communications through multiple applications in a timely and professional manner to ensure a positive patient experience.
Complies with all departmental and organizational policies and procedures.
Complies with local, state, and federal rules and regulations and the requirements of accrediting bodies.
Prioritizes work according to the department, hospital, and patient needs.
Independently works to resolve patient and provider questions related to prior authorizations, referrals, and insurance verification.
Acts as a liaison between the patient, payer, provider and clinical support staff.
Responsible for managing/setting up peer to peers and/or appeals for providers in a timely and professional manner according to individual plan guidelines.
Work with all necessary parties to ensure patients are rescheduled/ notified of denials promptly.
Responsible for understanding and staying current and up to date on payer regulations.
Accurately provide expected timeframes /payer guidelines to patients and providers regarding prior authorization/ financial clearance.
Maintains compliance with all company policies, procedures and standards of conduct
Complies with HIPAA privacy and security requirements to maintain confidentiality at all times
Performs other duties as assigned
Education
Additional Job Description:
High School Diploma or equivalent (required)
Experience
At least one year of patient access, insurance verification, prior authorization, or related experience (required)
3 Years Of Prior Authorization Or Related Experience (preferred)
Medical Terminology preferred
Preferred Qualifications
Healthcare experience preferred.
Electronic Health Record Experience Preferred.
Knowledge of EIPC. Seniority level
Seniority level
Entry level Employment type
Employment type
Full-time Job function
Job function
Other Industries
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Precertification Specialist, UofL Outpatient Center, Days
role at
UofL Health 1 day ago Be among the first 25 applicants Join to apply for the
Precertification Specialist, UofL Outpatient Center, Days
role at
UofL Health Get AI-powered advice on this job and more exclusive features. Address
401 E. Chestnut St. Louisville, KY 40202 Address
401 E. Chestnut St. Louisville, KY 40202
Shift
First Shift (United States of America)
Job Description Summary
UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehab Institute and Brown Cancer Center.
With more than 12,000 team membersphysicians, surgeons, nurses, pharmacists and other highly skilled health care professionalsUofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.
The Precertification Specialist sets the precedence to ensure a positive patient experience for upcoming surgical procedures and diagnostic tests by accurately and efficiently completing all necessary steps related to prior authorization, medical necessity determination and financial clearance for the hospital system and physician services for clinics, adult acute facilities and diagnostic centers.
Job Description
Accurately and efficiently identifies all appropriate and necessary clinical documentation to support medical necessity for all scheduled procedures/medication orders for multiple service lines and clinics.
Submits authorizations and clinical information to the appropriate payer/benefit manager in a timely fashion in compliance with plan rules including appropriately utilizing the CMS IP Only list.
Assesses orders to determine appropriate patient class and works with physicians to clarify as necessary
Contacts insurance plan/payers to determine eligibility, coverage information for specific procedures and benefit information
Coordinates patient encounters using multiple systems applications, various registration applications, clinical operating systems, eligibility verification systems and medical necessity applications.
Documents all findings/communications thoroughly and accurately in the patient record.
Meets or exceeds productivity standards in the completion of daily assignments and accurate production.
Documents all authorization information accurately in the referral as necessary to produce a clean transaction with the payer.
Answer and responds to all communications through multiple applications in a timely and professional manner to ensure a positive patient experience.
Complies with all departmental and organizational policies and procedures.
Complies with local, state, and federal rules and regulations and the requirements of accrediting bodies.
Prioritizes work according to the department, hospital, and patient needs.
Independently works to resolve patient and provider questions related to prior authorizations, referrals, and insurance verification.
Acts as a liaison between the patient, payer, provider and clinical support staff.
Responsible for managing/setting up peer to peers and/or appeals for providers in a timely and professional manner according to individual plan guidelines.
Work with all necessary parties to ensure patients are rescheduled/ notified of denials promptly.
Responsible for understanding and staying current and up to date on payer regulations.
Accurately provide expected timeframes /payer guidelines to patients and providers regarding prior authorization/ financial clearance.
Maintains compliance with all company policies, procedures and standards of conduct
Complies with HIPAA privacy and security requirements to maintain confidentiality at all times
Performs other duties as assigned
Education
Additional Job Description:
High School Diploma or equivalent (required)
Experience
At least one year of patient access, insurance verification, prior authorization, or related experience (required)
3 Years Of Prior Authorization Or Related Experience (preferred)
Medical Terminology preferred
Preferred Qualifications
Healthcare experience preferred.
Electronic Health Record Experience Preferred.
Knowledge of EIPC. Seniority level
Seniority level
Entry level Employment type
Employment type
Full-time Job function
Job function
Other Industries
Hospitals and Health Care Referrals increase your chances of interviewing at UofL Health by 2x Get notified about new Specialist jobs in
Louisville, KY . (Remote) Logistics & Customer Operations Specialist Manufacturing Supply Chain / FTL & Inventory
Document Management Specialist (Evening Shift: 11:30am - 8:00pm)
Real Estate Corporate Transactions Specialist
Customer Relations Specialist- Louisville
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Louisville, KY $54,000.00-$108,000.00 2 weeks ago Louisville, KY $45,000.00-$50,000.00 1 week ago Therapy Development Specialist (Louisville)
Louisville, KY $90,000.00-$100,000.00 5 days ago Existing Program! Document Management Specialist
Louisville, KY $50,000.00-$60,000.00 2 months ago Were unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr