Clinical Clearance Representative

Job Summary -
Contacting insurance companies, physicians, and patients to ensure that pre-certification and/or pre-authorization determination can be made for scheduled services. This may include liaising with physician offices and third party payors. Also responsible for ensuring adherence to payor medical necessity guidelines and MRH medical necessity policies as well as conducting payor notifications for non-scheduled inpatient encounters. This position reports to the Pre-Service Supervisor

Regulatory Requirements

• MINIMUM EDUCATION REQUIRED: High school degree or GED.
• MINIMUM EXPERIENCE REQUIRED: At least two (2) previous years of related healthcare Revenue Cycle experience specifically with precertification/authorization experience. Understanding of Medical Terminology and clinical documentation which must be demonstrated through prior education or work history.
• ADDITIONAL PREFERRED QUALIFICATIONS: At least three (3) previous years of related healthcare Revenue Cycle experience, preferably within pre-certification setting. A license or certification within the medical field, such as an CMA, LPA, certified coder, or RN.

Language Skills

• Ability to communicate in English, both verbally and in writing.
• Additional languages preferred.
• Excellent interpersonal skills.

Skills

• Clear understanding of the impact Clinical Clearance has on Revenue Cycle operations and financial performance.
• Excellent written, verbal communication and interpersonal skills.
• Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment.
• A demonstrated ability to use PC based office productivity tools (e.g. Microsoft Outlook, Microsoft Excel) as necessary; general computer skills necessary to work effectively in an office environment.
• Dedication to treating both internal and external constituents as clients and customers, maintaining a flexible customer service approach and orientation that emphasizes service satisfaction and quality.