Precertification Specialist-2

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:

40

Department:

Denial Management

Overview of Position:

Responsible for validating patient coverage and securing an authorization for services as deemed appropriate by the payer guidelines and contracts. Coordinates with the physician office, payer, and patient to ensure timely completion of authorization so as not to delay care. Demonstrates full understanding of insurance regulations related to payer authorizations for services prior to service and acts as a liaison between the patient and payer to secure that authorization.

ESSENTIAL DUTIES

1.    Demonstrates understanding of insurance payers and how to comply with differences in payer guidelines related to insurance authorizations for scheduled services.
2.    Understands technology platforms required to submit authorizations via portals, websites or other as deemed necessary by the payer regulations.  
3.    Clear understanding of documentation requirements within Epic to secure correct authorization number and/or notes within referral into correct fields that transition to claim form.
4.    Working knowledge of referral process, registration process and workflow within epic to secure physician referral and appointment criteria necessary to perform authorization checks with the payers.
5.    Working knowledge of all exam protocols, conservative treatment requirements, and/or other clinical data that would need submitted to secure an authorization prior to service. 
6.    Ability to customize service to fit the needs of the referring physician's and their staffs. 
7.    Verifies all coverage information to ensure correct guarantor, payer, subscriber numbers and group plans all valid for dates of services.  
8.    Works with the physician's office staff to obtain the necessary documentation related to securing the including pre-authorizations for services in a timely manner.
9.    Demonstrates understanding of medical diagnosis with correct spelling.
10.    Demonstrates understanding and ability to apply patient access/central scheduling policies and procedures.
11.    Consistently coordinates work to achieve maximum productivity and efficiency during the assigned shift. 
12.    Demonstrates a willingness to stay late, work weekends or other shifts to accommodate department needs.
 

QUALIFICATIONS
1.    High school graduate or equivalent.
2.    Knowledge of insurance verification, with one-two years’ experience verifying and obtaining medical pre-certification.
3.    Solid written and verbal communication skills.
4.    Strong computer experience, including MS Word and Excel, and experience using other office equipment. Will be required to learn department-specific programs.
5.    Demonstrated ability to prioritize and handle multiple tasks simultaneously.
6.    Ability to work with minimal supervision and effectively solve problems.
7.    Working knowledge of medical terminology.

PATIENT CENTERED CARE AND BEHAVORAL 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 make 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 to 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.
•    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 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 hospital outpatient environment
2.    Ability to sit for long periods of time
3.    Answers telephone calls, uses personal computer, other business machines and medical equipment, which require the ability to apply finger dexterity.  Individual bends, reaches, pushes and pulls.
4.    Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds.
5.    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.