SnowmassRecruiter Since 2001
the smart solution for Snowmass jobs

Pre-Certification Specialist of Outpatient Clinics

Company: Aspen Valley Hospital
Location: Snowmass
Posted on: January 11, 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 situationsThe 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 DUTIESPerforms 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 SERVICEDemonstrates purposeful service excellence through exceeding patient and coworker expectations.Represents the department/hospital as a dedicated, courteous, and responsive employeeCOMPLIANCE WITH RULES, REGULATIONS AND POLICIESRecords 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 OPERATIONS100% 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.PROFESSIONALISMDemonstrates responsibility and accountability for own professional decision making and professional growth.Participates and contributes to departmental meetings and activities.POPULATION SPECIFIC CRITERIADemonstrates 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 VALUESPatient 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 agendasRespect 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 stakeholdersAccountability: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 customersIntegrity: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 independentlyLANGUAGE 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, Other , Snowmass, Colorado

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


Massage Therapist (Winter Seasonal) - Ritz-Carlton, Bachelor Gulch (17002PUK)
Description: Massage Therapist Winter Seasonal We make stories like this possible every day. Whether were helping a budding chef create a favorite meal, or an anxious dad find a camera full of memories, were proud (more...)
Company: Marriott
Location: Aspen
Posted on: 01/24/2020

FT & PT Hospitality Positions
Description: FT PositionsFront Desk AgentPT PositionsSki
Company: Tivoli Lodge
Location: Vail
Posted on: 01/24/2020

Looking For A Pet Sitter For 4 Dogs In Grand Junction
Description: Grand Junction family needs a
Company: Care.com
Location: Grand Junction
Posted on: 01/25/2020


FT & PT Hospitality Positions
Description: FT PositionsFront Desk AgentPT PositionsSki
Company: Tivoli Lodge
Location: Vail
Posted on: 01/25/2020

Cook, Unit Clerk, Security Specialist
Description: Join our team and be a part of our Specialized and Unique Health Care cultureNow Hiring Looking for a rewarding career with excellent benefits and tuition
Company: Vail Health
Location: Vail
Posted on: 01/24/2020

FT & PT Hospitality Positions
Description: FT PositionsFront Desk AgentPT PositionsSki
Company: Tivoli Lodge
Location: Vail
Posted on: 01/24/2020

Benefits Advisor
Description: Job Description: br br Job Description: The Aflac Benefits Advisor works directly with business owners to deliver voluntary, healthcare and other benefits for their employees. It's a key role from (more...)
Company: AFLAC
Location: Grand Junction
Posted on: 01/25/2020

Counter Staff
Description: Counter StaffOllies Aspen Counter Staff Needed, Full Time/Part Time. Ollies Aspen Aspen area preferred. Job ResponsibilitiesGreet customers as they come into the caf and
Company: Ollies Aspen
Location: Aspen
Posted on: 01/24/2020

Advanced Lift Electronics - Year Round
Description: Company Vail Resorts - Location Vail, CO 81657 Description Reach Your Peak at Vail Resorts. Youaposre someone
Company: Vail Resorts
Location: Vail
Posted on: 01/25/2020

CLASS A CDL - OTR COMPANY TRUCK DRIVER - GUARANTEED PAY! (Grand Junction)
Description: CLASS A CDL - OVER THE ROAD - COMPANY TRUCK DRIVER - GUARANTEED PAY GO FIRST CLASS OTR Class A CDL Truck Drivers are the backbone of May Trucking Company. We never forget that our success as an organization (more...)
Company: May Trucking
Location: Grand Junction
Posted on: 01/25/2020

Log In or Create An Account

Get the latest Colorado jobs by following @recnetCO on Twitter!

Snowmass RSS job feeds