Pre-Certification Specialist of Outpatient Clinics

Company: Aspen Valley Hospital
Location: Snowmass
Posted on: March 17, 2020

Job Description:

The Pre-Cert staff is responsible for complete and accurate estimates, pre-authorizations and pre-certifications.# This includes the proper and accurate completion of required insurance benefits, authorizations and waivers as well as patient estimates, claim authorization and insurance submission information. They must be familiar and compliant with all insurance contracts, Medicare and Medicaid regulations as well as with Aspen Valley Hospital (AVH) compliance requirements, policies, rules and regulations. The Pre-Certification staff practices exceptional customer service and professionalism. They must act as a liaison between Hospital departments, staff, physician offices and the patient to effectively coordinate scheduling of tests and procedures. They are responsible for the pre-authorization function to assure accurate and timely payer information and fiscal responsibility. They are responsible for communicating to the patient any issues that may affect their procedure not being covered, for any reason. The Pre-Certification staff#s daily responsibilities are directed by the Patient Access Director. ESSENTIAL JOB DUTIES Performs accurate pre-certification using thorough interview techniques to ensure that information is 100% complete and accurate.# Ensures that all compliance requirements have been met, and the registration is properly created and/or updated for anticipated billing. Proper and accurate completion of required insurance benefits, authorizations and waivers as well as patient estimates, claim authorization and insurance submission information.# Responsible for the pre-authorization function to assure accurate and timely payer information and fiscal responsibility.# They are responsible for communicating to the patient any issues that may affect their procedure not being covered, for any reason.# SERVICE EXCELLENCE/CUSTOMER SERVICE Demonstrates purposeful service excellence through exceeding patient and coworker expectations. Represents the department/hospital as a dedicated, courteous, and responsive employee COMPLIANCE WITH RULES, REGULATIONS AND POLICIES Records pertinent documentation in accordance with regulatory requirements, professional standards and hospital policy. Adheres to federal, state and hospital rules and regulations concerning HIPAA privacy and security. Follows Hospital compliance plan and policies, including the Code of Conduct. Participates in required training for compliance related activities (HIPAA, Compliance, Patient Safety, TJC, etc.) UNIT SPECIFIC DUTIES # RESPONSIBILITIES / DAY TO DAY OPERATIONS 100% correct pre-certification, verifying all patient insurance information, and insurance verifications, Understand and complies with all Hospital, EMTALA, patient confidentiality, Advance Directives, ABN#s and Insurance waivers. 100% correct pre-admission data that includes review of type of account, #correct procedure, duplications of registration of M#, subscriber errors, and correct patient estimation. Fiscal responsibility that includes reviewing and competing ABN#s, insurance waivers, and ensuring completed pre-certification as needed. #They are responsible for communicating to the patient any issues that may affect their procedure not being covered, for any reason.# Participates in department training and staff meetings. Reads daily summary reports and emails to ensure they are aware of any upcoming changes. PROFESSIONALISM Demonstrates responsibility and accountability for own professional decision making and professional growth. Participates and contributes to departmental meetings and activities. POPULATION SPECIFIC CRITERIA Demonstrates the ability to assess and interact with customers of all ages, recognizing language and learning barriers, and technology challenges. Able to state his/her duties during a code pink drill. CORE VALUES Patient Centered:is passionate about patient care, creating positive impressions on a consistent basis and exceeding our patients# expectations. Exhibits courtesy and sensitivity to the needs of patients and their families, responds with a sense of urgency to patient problems, anticipates patient requirements, responds proactively and places the patient#s safety above all else. Teamwork:works collaboratively with physicians and other staff and assists whenever possible. He/she openly shares information, provides feedback and participates in appropriate decision making as part of a team of healthcare professionals. Hospital and departmental objectives are placed ahead of individual agendas Respect for Others:actively listens to others, takes other opinions into account, and communicates openly and honestly.# He/she demonstrates respect for others by being timely with communications, completion of tasks, and meeting attendance.# The employee is respectful of all physicians, colleagues, patients, visitors, and other stakeholders Accountability:takes responsibility for his/her actions, abides by the hospital#s guiding philosophies and policies, and follows through on commitments and physician orders.# He/she provides complete and accurate information to the Physician and/or other members of the work team. takes personal pride and ownership in the quality of care and services provided to all internal and external customers Integrity:is truthful, trustworthy, and principled.#He/she#demonstrates character, conviction, and honest and ethical behavior in all interactions with others.##The employee#s word can be trusted.##Behavior is#consistent with these AVH Core Values # EDUCATION/EXPERIENCE REQUIREMENTS # ##########2-3 years of experience in related field strongly preferred # KNOWLEDGE AND SKILL REQUIREMENTS # ######### Ability to concentrate and show attention to detail ######### Relatively high degree of analytical abilities ######### Strong interpersonal skills required ######### Ability to work independently LANGUAGE SKILLS # ######### Ability to read and communicate effectively in English ######### Spanish preferred # WORKING CONDITIONS # ######### Normal patient care environment with little exposure to excessive noise, dust and temperature ######### May be exposed to communicable diseases through normal or careless performance of responsibilities ######### May be exposed to mechanical dangers associated with mechanical devices ######### May be exposed to stressful situations

The Pre-Cert staff is responsible for complete and accurate estimates, pre-authorizations and pre-certifications. This includes the proper and accurate completion of required insurance benefits, authorizations and waivers as well as patient estimates, claim authorization and insurance submission information. They must be familiar and compliant with all insurance contracts, Medicare and Medicaid regulations as well as with Aspen Valley Hospital (AVH) compliance requirements, policies, rules and regulations. The Pre-Certification staff practices exceptional customer service and professionalism. They must act as a liaison between Hospital departments, staff, physician offices and the patient to effectively coordinate scheduling of tests and procedures. They are responsible for the pre-authorization function to assure accurate and timely payer information and fiscal responsibility. They are responsible for communicating to the patient any issues that may affect their procedure not being covered, for any reason. The Pre-Certification staff's daily responsibilities are directed by the Patient Access Director.

ESSENTIAL JOB DUTIES

Performs accurate pre-certification using thorough interview techniques to ensure that information is 100% complete and accurate. Ensures that all compliance requirements have been met, and the registration is properly created and/or updated for anticipated billing.

Proper and accurate completion of required insurance benefits, authorizations and waivers as well as patient estimates, claim authorization and insurance submission information.

Responsible for the pre-authorization function to assure accurate and timely payer information and fiscal responsibility. They are responsible for communicating to the patient any issues that may affect their procedure not being covered, for any reason.

SERVICE EXCELLENCE/CUSTOMER SERVICE

Demonstrates purposeful service excellence through exceeding patient and coworker expectations.

Represents the department/hospital as a dedicated, courteous, and responsive employee

COMPLIANCE WITH RULES, REGULATIONS AND POLICIES

Records pertinent documentation in accordance with regulatory requirements, professional standards and hospital policy.

Adheres to federal, state and hospital rules and regulations concerning HIPAA privacy and security.

Follows Hospital compliance plan and policies, including the Code of Conduct.

Participates in required training for compliance related activities (HIPAA, Compliance, Patient Safety, TJC, etc.)

UNIT SPECIFIC DUTIES & RESPONSIBILITIES / DAY TO DAY OPERATIONS

100% correct pre-certification, verifying all patient insurance information, and insurance verifications, Understand and complies with all Hospital, EMTALA, patient confidentiality, Advance Directives, ABN's and Insurance waivers.

100% correct pre-admission data that includes review of type of account, correct procedure, duplications of registration of M#, subscriber errors, and correct patient estimation.

Fiscal responsibility that includes reviewing and competing ABN's, insurance waivers, and ensuring completed pre-certification as needed. They are responsible for communicating to the patient any issues that may affect their procedure not being covered, for any reason.

Participates in department training and staff meetings. Reads daily summary reports and emails to ensure they are aware of any upcoming changes.

PROFESSIONALISM

Demonstrates responsibility and accountability for own professional decision making and professional growth.

Participates and contributes to departmental meetings and activities.

POPULATION SPECIFIC CRITERIA

Demonstrates the ability to assess and interact with customers of all ages, recognizing language and learning barriers, and technology challenges.

Able to state his/her duties during a code pink drill.

CORE VALUES

Patient Centered:is passionate about patient care, creating positive impressions on a consistent basis and exceeding our patients' expectations. Exhibits courtesy and sensitivity to the needs of patients and their families, responds with a sense of urgency to patient problems, anticipates patient requirements, responds proactively and places the patient's safety above all else.

Teamwork:works collaboratively with physicians and other staff and assists whenever possible. He/she openly shares information, provides feedback and participates in appropriate decision making as part of a team of healthcare professionals. Hospital and departmental objectives are placed ahead of individual agendas

Respect for Others:actively listens to others, takes other opinions into account, and communicates openly and honestly. He/she demonstrates respect for others by being timely with communications, completion of tasks, and meeting attendance. The employee is respectful of all physicians, colleagues, patients, visitors, and other stakeholders

Accountability:takes responsibility for his/her actions, abides by the hospital's guiding philosophies and policies, and follows through on commitments and physician orders. He/she provides complete and accurate information to the Physician and/or other members of the work team. takes personal pride and ownership in the quality of care and services provided to all internal and external customers

Integrity:is truthful, trustworthy, and principled. He/she demonstrates character, conviction, and honest and ethical behavior in all interactions with others. The employee's word can be trusted. Behavior is consistent with these AVH Core Values

EDUCATION/EXPERIENCE REQUIREMENTS

-- 2-3 years of experience in related field strongly preferred

KNOWLEDGE AND SKILL REQUIREMENTS

-- Ability to concentrate and show attention to detail

-- Relatively high degree of analytical abilities

-- Strong interpersonal skills required

-- Ability to work independently

LANGUAGE SKILLS

-- Ability to read and communicate effectively in English

-- Spanish preferred

WORKING CONDITIONS

-- Normal patient care environment with little exposure to excessive noise, dust and temperature

-- May be exposed to communicable diseases through normal or careless performance of responsibilities

-- May be exposed to mechanical dangers associated with mechanical devices

-- May be exposed to stressful situations

Keywords: Aspen Valley Hospital, Snowmass , Pre-Certification Specialist of Outpatient Clinics, Healthcare , Snowmass, Colorado