Overview

Contacts insurance companies and other third party payers to determine pre-certification, pre-authorization and/or medical necessity requirements for complex outpatient hospital services, and specialized procedures (i.e. Recurring Visits, Surgeries, IR). Obtains pre-certification or pre-authorization prior to the scheduled complex service being performed. Liaisons with physicians and physician office staff when needed to obtain additional demographic, insurance or clinical information. Notify payers of admittance if required.

Responsibilities

Contacts insurance companies and other third party payers to determine pre-certification, pre-authorization and/or medical necessity requirements for complex outpatient hospital services, and specialized procedures (i.e. Recurring Visits, Surgeries, IR). Obtains pre-certification or pre-authorization prior to the scheduled complex service being performed. Liaisons with physicians and physician office staff when needed to obtain additional demographic, insurance or clinical information. Notify payers of admittance if required.

Qualifications

Education H.S. Diploma or General Education Degree (GED) Required Bachelor’s Degree from a recognized college or university Preferred Completion of medical coder training program Preferred Work Experience 3 years exp in Rev Cycle or related exp in healthcare, with one of those years working specifically within Healthcare Revenue Cycle Required 4 years of previous related healthcare Revenue Cycle experience Preferred Prior Epic experience Preferred Clinical experience (i.e., medical assistant, surgical tech) Preferred Licenses and Certifications None Required Certification with Healthcare Financial Management Association Preferred Certified Revenue Cycle Representative Preferred Business Unit : Company Name Piedmont Healthcare Corporate