Precertification Specialist Assistant

Position Summary

The PreCertification Specialist Assistance (PSA) is responsible for reviewing scheduled elective accounts to ensure that certification has been obtained. The PSA will maintain open communication and be available to component organizations and practitioner sites for consultation. The PSA will provide excellent internal and external customer service and maintain a working knowledge of industry standards to ensure timely, quality services in accordance with contractual agreements, federal regulations, hospital policies, procedures and professional standards.

Education

High School Diploma - Preferred

Experience

2-3 Years Clerical - Required

1-2 Years Insurance - Preferred

License & Certification

None Required

Core Job Functions

Compile and distribute daily service report. Review account to determine if certification is required. Work with physician offices and other hospital departments to make sure required certification is obtained and documented.

Determines if authorization is required. Accurately documents account information.

Monitor various reports for precertification need. Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.

Review updated information from payers, Monitor web portal alerts from payer. Maintains updated files on specific payer requirements.