Pre-Certification Coordinator, Full Time
Company: Partners Healthcare System
Posted on: July 31, 2022
Responsibilities include contacting insurance plans and/or
authorizing agencies to obtain prior approval for scheduled
surgical/ancillary events. This individual will be responsible for
understanding all payer requirements and supporting the
pre-certification/authorization process for all outpatient,
surgical and ancillary procedures with the insurance carriers.
1. Work collaboratively and confidentially with support staff as
well as other hospital departments, insurance carriers/authorizing
agencies to obtain required pre-certification/approval for
2. Work collaboratively with health insurance carriers to
verify/confirm eligibility. 3. Establish a contact network with the
plans/agencies that will enable the pre-certification process to
work quickly and efficiently.
4. Record all information related to approvals and denials
including but not limited to the approval number, the date of the
approval and name of the contact that are communicated to the
provider in EPIC.
5. Communicate all pre-certification and/or authorization denials
with MEE Financial Counselors and clinical areas.
6. Work closely with the physicians and their support staff to
obtain the detailed information required to pre-certify a service.
This includes obtaining complete registration, insurance, and the
clinical data necessary for completing the
7. Collaborate with support staff in situations where insurance
carriers require additional clinical information such as peer to
8. Work with Primary Care Physicians offices to obtain appropriate
referrals and authorizations. Confirm this information with
insurance carrier prior to the scheduled date.
9. Maintain strict confidentiality regarding all patient matters.
Secure confidential information through the workday.
* Minimum of three years' experience in a health care setting.
* Current knowledge of CPT/ICD-10-CM coding preferred.
* Previous experience with pre-certification/approval processes and
knowledge on managed care and other health insurance polices
* Must possess the ability to communicate and deal effectively with
patients, physicians, visitors, and peers in the course of
performing job responsibilities.
Keywords: Partners Healthcare System, Quincy , Pre-Certification Coordinator, Full Time, Other , Quincy, Massachusetts
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