Precertification Specialist Home Health

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High School Diploma or equivalent.

EXPERIENCE:

1. Two years' experience in insurance and precertification process.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Medical Assistant certification

CORE DUTIES AND RESPONSIBILITIES:The statements described hereare intendedto describe the general nature of work being performed by people assigned to this position. Theyare not intended to be constructedas an exhaustive list of all responsibilities and duties. Other dutiesmay be assigned.

1. Utilizes standardized EPIC processes to obtain and document initial and ongoing authorization numbers, and any additional information that anyone who needs it has access to it in the care of or billing of patient services.

2. Maintains a process for efficiency to assure no prior or ongoing authorizationis missed.

3. Use hospital computer systems or other electronic media 100% of time in creation of complete history of precertification and ongoing certification process as means of communicating job function.

4. Participate in random audits, and be prepared to adapt corrective action whenneeded, including, but not limited to, ongoing education, and compliance education.

5. Competency in these areaswill be measured by ongoing review of denials, payment, accounts receivable (AR) review, and other appropriate audit tools such that UHC provider status or reimbursement status is not adversely or negatively impacted in any way.

6. Maintains current knowledge of CPT coding and HCPC's in order to be able toprecert/authorize home health/hospice referrals.

7. Processes and analyzes all medical documentation along with all completed testing in order to give complete information to insurance companies as well as any other program necessary to obtain preauthorization/precertification.

8. Provides audit documentation as requested to respective departments.

9. Relays critical information to director and other department leaders and other associates within established guidelines.

10. Keeps an up to date record of all coordinated responsibilities

11. Uses all equipment and resources appropriately in order to maintain flow of information and to maximize time management.

12. Correctly sequence insurance plans and appropriately record all insurance plans for each patient as part of overall use of patient billing systems as part of overall job functions.

13. Performs standard office functions as needed (mail, supplies, etc.) when staff deficiencies occur due to illness, emergencies etc. and cooperate with department leaders at all times.

PHYSICAL REQUIREMENTS:The physical demands described here are representative of those thatmust be metby an employee to successfully perform the essential functions of this job. Reasonable accommodationsmay be madeto enable individuals with disabilities to perform the essential functions.

1. Frequent body movements to perform daily work

2. Read and write English with visual acuity in normal range.

3. Manual dexterity for equipment use.

WORKING ENVIRONMENT:The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodationsmay be madeto enable individuals with disabilities to perform the essential functions.

1. Exposure to electric current

2. Frequent interruptions.

SKILLS AND ABILITIES:

1. Knowledge, by experience, testing, or academic course work completion of CPT, ICD 10, HCPC, LMRPs, and similar coding/guidelines for purposes of being able to abstract medical record information sufficient to collect the necessary information acceptable to the third partypayoror other agency i.e. worker's compensation program) that would grant authorization forpost acutecare to provide specialty specific services,

2. Knowledge of third partypayorrequirements, contracts, authorization and payment practices required as well as ability to maintain knowledge of contracts as they change over time; attention to detail in the case of payment dispute

3. Knowledge of EPIC platform preferred, although otherswill be takenin consideration, if appropriate.

4. Able to complete tasks in a consistent manner.

5. Ableto effectively communicatewith the public and health care team in a courteous and professional manner.

6. Able to prioritize tasks and has the skill to multitask.

7.Medical terminology experience.

Additional Job Description:

Thorough understanding of insurance verification and authorizations specifically for HH/HSPC will have first consideration. Excellent customer service skills and phone etiquette a must

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center:

Address:

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.