Pre-Certification Coordinator II – Department of Medicine

Responsibilities

• Completes pre-certifications for complex and specialized services as indicated on therapy and treatment plans
• Reads and analyzes therapy and treatment plans, drug protocols, and clinical documentation
• Completes authorization process with the payer and in EPIC
• Completes rechecks on existing pre-certifications by verifying insurance eligibility
• Works with clinical staff and providers on add-ons, denials and peer to peers through to resolution
• Performs other duties as assigned

Requirements

• High school diploma or equivalent high school certification or combination of education and/or experience
• 3 years experience in Clinical Office, Medical Billing, Health Information Management (Him), or Pre-Certification
• No specific certification/professional license required
• Communication skills
• Detail-oriented
• Proficient in Epic EHR
• Experience in Insurance Claim Processing Software
• Understanding of Insurance Terminology
• Ability to interact with all levels of management

Core Competencies

Demonstrates expertise in pre-certification processes, including authorization and insurance eligibility verification, while effectively collaborating with clinical staff and providers. Proficient in utilizing Epic EHR and insurance claim processing software to ensure accurate and timely completion of clinical documentation.