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Precertification Coordinator, Roger C. Peace Rehabilitation Hospital
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![]() United States, South Carolina, Greenville | |
![]() 300 East McBee Avenue (Show on map) | |
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Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for the financial and clinical aspects of all referrals made to the program, including logging all referrals, collecting and verifying pertinent demographic and financial data as well as obtaining pre-certifications and authorizations for new and ongoing treatment. Interacts regularly with internal customers, third party payors and outside referral sources. Performs complex tasks using Microsoft Office applications. Responsible for compliance issues related to medical necessity and coding.Accountabilities * Processes and tracks incoming referrals.\u00A0 Logs all incoming referrals according to program guidelines.\u00A0 Obtains medical records to support referrals.\u00A0 Prepares referral with clinical and financial information for submission to Program Director.\u00A0 Coordinates patient assignment to case management and communicates with referral source as to the status of the referral.\u00A0 25% * Advocates for and secures coverage for all patients referred for services.\u00A0 Explains the unique aspects of the program to insurance representatives and provides the program description to all third party payors in order to increase accuracy of pre-certification determinations and financial information. Verifies insurance benefits to include all possible services and CPT codes billed by program and need for pre-certification or pre-authorization for treatment.\u00A0 Pursues any needed clarification of insurance benefits prior to scheduling of patients. Obtains staffing requirements related to third party payors based on requirements for in-network providers and communicates information to case management to maximize reimbursement. Maintains public relations with patients and third party payors, including insurance case managers, in accordance with GHS Service Excellence standards.\u00A0 25%* Collects and verifies pertinent patient demographics and financial data on all new patient referrals with physician offices and other referral sources.\u00A0 Communicates with referral source to obtain additional information required for completing referral, including ICD-9 coding as well as ascertaining appropriate medical records to determine eligibility for program admission.\u00A0\u00A0 15% * Collects and verifies pertinent patient demographics and financial data on all ongoing patients under continuing treatment.\u00A0 Obtains continuing authorizations for treatment under 3rd party payor guidelines and\u00A0time frames\u00A0and completes required documentation.\u00A0 Facilitates documentation needs by third party payors for continuing treatment.\u00A0 Provides initial advocacy and informational needs for recurring treatment with\u00A0third\u00A0party payors and notifies case management of\u00A0additional\u00A0contact required.\u00A0\u00A0 15% * Performs compliance functions related to coding, billing, demographics and and payor source.\u00A0 Facilitates ICD-9 codes on initial orders.\u00A0 Coordinates supplemental ICD-9 coding to support medical necessity of treatment and communicates to GHS Medical Information Department in a timely manner.\u00A0 Monitors timeliness of physician continuing orders for treatment for all program and PRN patients.\u00A0 10% * Performs multiple business office functions using MS Office applications.\u00A0 Coordinates patient scheduling process, updates waiting lists, prepares written communication to physicians regarding referrals and performs database entry. 10%Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Education High School diploma or equivalent\u00A0 Minimum Experience 2 years-\u00A0Insurance, billing, collections, customer service and/or healthcare business office. Other Required Experience Knowledge of ICD-10 and CPT coding conventions- Preferred\u00A0 Work Shift Day (United States of America)Location Roger C Peace Rehab HospFacility 1010 Roger C Peace Rehabilitation HospitalDepartment 10109079 Post-Acute Bed PlacementShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health. |