In an environment of continuous quality improvement, the Precertification Assistant is responsible for assisting with the review of scheduled tests and surgeries, to verifying insurance information and coverage, determine authorizations, medical necessity is obtained, or medical coverage, for proper payment of testing. Exhibits the MHS Standards of Excellence and exercises strict confidentiality at all times.
· Minimum of 2 years' experience in hospital, medical office or clinic setting in registration dealing with insurance issues and/or scheduling experience required
· Previous education in medical terminology, anatomy and physiology, or graduate/certification from medical office program preferred
· If no previous education, anatomy and physiology will be required within 6 months of employment
· Must have or be able to acquire and retain good knowledge of commercial, federal and state payor requirements
· Needs good telephone voice and skill in handling business transactions, including irate patients
· Ability to work with computerized system, also basic clerical and interpersonal skills and typing at 40 wpm
· Ability to read, write and do math as generally demonstrated by a high school diploma or GED
1. Determines insurance coverage for patient and testing/services.
2. Obtains appropriate authorizations, medical necessity, or complies with coverage determinations to receive payment from insurance companies.
3. Tracks authorizations and places patient testing on hold if not obtained.
4. Assumes all other duties and responsibilities as necessary.