Pre-Certification Coordinator I (Remote) - Department of Medicine

📋 Description

• • Initiates and facilitates the pre-determination process for medical, surgical, and diagnostic services to ensure timely approval and reimbursement.
• • Contacts third-party insurance companies to verify patient benefits and obtain pre-certification for both surgical and nonsurgical procedures.
• • Notifies financial counselors regarding pre-payment requirements for services that have not yet been coded.
• • Supplies complete and accurate documentation to insurance providers as required during the pre-certification process.
• • Maintains the daily surgery and procedure schedule for department faculty, ensuring alignment with physician availability and clinic operations.
• • Communicates regularly with physicians and their assistants to coordinate scheduling and address changes or conflicts in procedure timelines.
• • Keeps a detailed written log of all pre-certifications in progress and tracks their status until approval is confirmed.
• • Documents receipt of pre-certification approvals from insurance companies and ensures timely communication with the hospital’s utilization and billing departments.
• • Performs administrative duties related to patient care coordination in a medical setting, including handling sensitive health information with confidentiality.
• • Works in a patient care environment with standard office equipment, requiring frequent use of computers and phone systems for external communications.
• • Adheres to all institutional policies and procedures while supporting efficient revenue cycle operations through accurate pre-certification practices.
• • Responds to evolving administrative needs as assigned, maintaining flexibility and attention to detail in a fast-paced healthcare environment.
• • Ensures compliance with payer requirements and internal protocols to maximize reimbursement and minimize claim denials.
• • Collaborates with internal teams including billing, utilization review, and clinical staff to streamline pre-authorization workflows.
• • Maintains accurate records and ensures all pre-certification activities are properly documented for audit and compliance purposes.