Mission statement

Superior health care and exceptional service for each person, every time.

Vision

To be a vibrant and thriving five-star center for health, serving as our community's first choice for health and wellness.

Our C.A.R.E. Values

• Compassion - I will treat everyone with kindness, acceptance, empathy, and understanding.
• Accountability - I will be trustworthy, responsible, and dependable while taking ownership of my actions.
• Respect - I will value the feelings, wishes, rights, and traditions of everyone without judgment.
• Excellence - I will strive to understand and exceed the expectations of others.

Job Description:

• Fulltime-Days

Benefits:

Medical Insurance- Three different plans to choose from

MASA- Medical Transportation Solutions

Health Reimbursement & Savings Account

Flex Spending Account/Dependent Care Spending Account

Dental

Vision

Identity Protection-Free

Hospital Indemnity

Life Insurance-Free

LTD/STD-Free

Voluntary Life & AD&D

403 (b) Retirement Plan- 4% employer contribution

ETO

EIB-Hospital contribution

JOB DESCRIPTION: Pre-Certification Clerk

JOB SUMMARY:

The Pre-Certification Clerk is responsible for obtaining authorizations from insurance companies for hospital services along with verifying patient eligibility and benefit information for the specific services to be performed.

ESSENTIAL ACCOUNTABILITIES:

1. Verifies insurance information through payer contacts via telephone, online resources, or electronic verification systems.

2. Identifies payer authorization/referral requirements.

3. Corrects and updates all necessary data to assure timely, accurate billing submission.

4. Maintains accountability for accuracy of data collected and entered into the computer system.

5. Provides appropriate documentation and follow up to patients, physician offices, case management/utilization review and payers regarding authorization/referral deficiencies.

6. Contacts insurance carriers or other physician offices to obtain prior authorizations.

7. Obtains/verifies pre-certification and/or authorization prior to services.

8. Identifies private-pay and/or under insurance patients and escalates accounts to a Patient Financial Service Representative.

9. Maintains up-to-date information on various insurance companies and any relevant changes.

10. Communicates important insurance data to appropriate staff.

Department Specific Accountabilities:

1. Follow and abide by all hospital policies and procedures to maintain employment with the hospital.

2. Must produce accurate and complete work.

3. Other duties as assigned.

Other Job Accountabilities:

1. Interacts with nurses, coders, and other clinical staff to gather information needed for precertification, prior approval, or pre-determination.

2. Will perform back up duties for the Patient Advocate / Precertification position. Those duties could include the following but are not limited to the following areas. Inpatient precertification, PT/OT/ST benefits and precertification, running VA and Bluestem reports, performing emergency care notifications for VA patients coming in through the ER and Walk-In-Care, running surgery schedule to endure precertification’s are received.

QUALIFICATIONS:

Education:

• High school education required.

Experience:

• Two or more years medical prior authorization experience preferred.

• Two or more years’ experience in a medical related field required.

• Knowledge of basic medical terminology.

Skills:

• Ability to multitask and remain focused while managing a high-volume, time-sensitive workload.

• Detail oriented with above average organizational skills.

• Plans and prioritizes to meet deadlines.

• Ability to work in a changing environment.

• Ability to change duties at a moment’s notice.

• PC skills required to become proficient in the use of a variety of computer-based systems.

• Exceptional follow-through and job execution skills – obtaining authorizations timely and following accounts through payment.

• Must be familiar with office equipment typically found in a business office environment.

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability, status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.