Precertification Analyst

GENESIS HEALTHCARE SYSTEM
 

In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an ‘owner’ of Genesis and keep our patients at the center of everything we do - always. 

Position Details:

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

24

Department:

Denial Management

Overview of Position:

The Precertification Analyst obtains and/or verifies demographic, clinical, financial and insurance information for both hospital and GMG office diagnostic procedures. The incumbent conducts online insurance eligibility/benefit verification, pre-certification/authorization, referral clearance and financial education on designated cases. As appropriate, the incumbent notifies patient/guarantor and collects patient liabilities, and refers appropriate cases to resource counseling for follow-up and consultation, including the entry of patient/guarantor information in the patient accounting system.

ESSENTIAL DUTIES
1.    Maintains working knowledge for carrier contracts/changes and hospital departmental policies and procedural changes.
2.    Analyzes information required to complete pre-certification and/or authorizations with insurance carriers, service area contracts and workman’s compensation carriers. 
3.    Performs financial clearance including pre-certifications for inpatient and outpatient patient types as well as other services. 
4.    Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms (EDI transactions, web access and by calling payers) and documenting information within the patient accounting system.
5.    Determines the benefits and need for appropriate service authorizations. 
6.    Validates medical necessity of Medicare and Non-Medicare cases to ensure clinical and financial clearance.  Contacts scheduling and/or appropriate department staff for clarification, if cases require clarification of diagnosis and/or tests/procedures. 
7.    Helps to insure patient is placed in the correct status according to CMS’s inpatient only procedure list.
8.    Communicates with patients, family members/guarantors, 3rd party payers, and physicians/office staff in the deployment of key activities 
9.    Provides assistance to other departmental personnel as needed.  Cross-trains in various functions as needed to assist in the smooth delivery of departmental services
10.    Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Genesis organizational integrity program, standards of conduct, as well as other policies and procedures in order to ensure adherence.

QUALIFICATIONS
1.    Current Ohio RN License. 
2.    At least one (1) year of experience performing insurance verification and/or pre-certifying procedures.
3.    Experience in clinical patient care setting desired
4.    Working knowledge of medical terminology, anatomy and physiology, and basic computer skills are high desirable.
5.    Must possess excellent verbal and written communication skills in dealing with internal and external customers.  
6.    Accuracy, attentiveness to detail, time management and problem solving skills are mandatory traits.  
7.    Must have a strong familiarity with current ICD-9, ICD-10 and CPT codes.
8.    Strong computer skills.
9.    Excellent organizational and time management skills with ability to handle multiple priorities simultaneously.
10.    Must be comfortable operating in a collaborative, shared leadership environment. 
11.    Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring.

PATIENT CENTERED CARE & BEHAVIORAL EXPECTATIONS
1.    Living the Genesis Mission, Vision and Values: 
• Performs work in a manner that is quality focused.
• Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect.
• Results oriented and focused on achievement of objectives.
• Acknowledges and responds to the diversity of people and the situation.
• Encourages peers (others) to be owners of change.
• Always makes the effort to anticipate and exceed customer needs and expectations.
• Possesses the ability to engage others with patience and understanding.
• Acts in a manner that creates positive first and lasting impressions.
• Demonstrates the ability to own issues until they are resolved.
2.    Patient Centered Care (patients/families, physicians, co-workers, all other internal/external customers)
• Introduces self and role…connects with everyone.
• Communicates effectively (i.e. advising others of actions, pertinent information, time durations, etc.) and asks for feedback.
• Asks for and anticipates needs and concerns of others.
• Maintains a positive work environment for staff and a healing environment for patients (i.e. safe, clean, quiet, etc.)
• Maintains the dignity and privacy of each person; manages confidential/sensitive information appropriately.
• Responds to requests in an appropriate and timely manner.
• Exits patient/customer encounters courteously, asking if there are additional needs that can be addressed.
3.    Promotes Patient and Employee Safety 
• Demonstrates safe Patient Handling (i.e. transfers, transport, care administration, nutrition, medication, etc.) 
• Demonstrates safe Materials Handling (i.e. appropriate use and disposal of chemicals, infectious wastes, etc.)
• Demonstrates appropriate knowledge of Infectious Disease precautions and use of proper protective equipment
• Demonstrates Slips/Trips and Falls Awareness.
• Actively contributes to maintaining a safe, clean and quiet environment.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

1.    Works in a clinical office or practice setting.  
2.    This position requires the ability to comprehend and retain information that can be applied to work procedures, including the assimilation of multiple test modalities and judgment in test sequencing to achieve appropriate timing of testing and patient flow.
3.    Will read, write and utilize manual and computerized systems and documentation.
4.    May occasionally lift and/or move up to 25 lbs.
5.    Occasionally climb, balance, stoop, kneel, crouch or crawl.
6.    Vision abilities required include up close vision, peripheral vision, depth perception and the ability to adjust focus

This description reflects in general terms the type and level of work performed.  It is not intended to be all-inclusive, nor portray the specific duties of any one incumbent.
 

Thank you for your interest in employment at Genesis. Genesis is committed to being an equal opportunity employer. Selection of applicants for employment is based only on qualifications and the requirements of a specific job.