St. Luke's is proud of the skills, experience and compassion of
its employees. The employees of St. Luke's are our most valuable
asset! Individually and together, our employees are dedicated to
satisfying the mission of our organization which is an unwavering
commitment to excellence as we care for the sick and injured;
educate physicians, nurses and other health care providers; and
improve access to care in the communities we serve, regardless of a
patient's ability to pay for health care.
The precertification specialist is responsible for contacting
health insurance companies prior to physician/provider office
visits, procedures, testing or admission to the hospital to verify
coverage either online or by telephone. The precertification
specialist is also responsible for relaying precertification
information to performing facility and for facilitating appeals if
initial approval is denied. Excellent phone skills and computer
skills are needed. Previous medical terminology background is
1. Receives instructions from the physician/provider regarding
what procedure or testing is needed.
2. Issue and/ or obtain precertification/preauthorization from
insurance companies prior to procedure or testing utilizing an
online application or contacting the insurance company by
3. Issue and/or obtain insurance referrals from insurance
companies prior to physician/provider office visits utilizing an
online application, a paper form or by contacting the insurance
company by telephone.
4. Verifies patient eligibility and coverage for the procedure
using an online application or by telephone. If the patient is not
eligible on date of service or procedure is not covered, this
information is relayed to the physician/provider and the
5. Maintains online log of patient's requiring
6. Maintains working knowledge of Navinet and RadMD (online
insurance referral and precertification application)
7. Demonstrates competency in assigned areas of
8. Responds to written and telephone inquiries from patients,
insurance carriers and facilities regarding planned services.
9. Maintains detailed knowledge of computer software systems as
it relates to job functions.
10. Takes an active role in facilitation team approach to
functions within the department:
o Attends departmental meetings
o Actively participates as a team member in resolution of
problems as they are
o Analyzes current procedures, bringing suggestions for
improvement to the attention
o Document authorizations in medical record and provide to
11. Proficient in Electronic medical record program used in
12. Maintains confidentiality of all materials handled within
the Network/ Entity as well as the proper release of
13. Complies with Network and departmental policies regarding
issues of employee, patient and environmental safety and follows
appropriate reporting requirements.
14. Demonstrates/models the Network's Service Excellence
Standards of Performance in interactions with all customers
(internal and external).
15. Demonstrates Performance Improvement in the following areas
as appropriate: Clinical Care/Outcomes, Customer/Service
Improvement, Operational System/Process, and Safety.
16. Demonstrates financial responsibility and accountability
through the effective and efficient use of resources in daily
procedures, processes and practices.
17. Complies with Network and departmental policies regarding
attendance and dress code.
18. Demonstrates competency in the assessment, range of
treatment, knowledge of growth and development and communication
appropriate to the age of the patient treated.
19. Contacts Central Scheduling, Patient Access Department, and
patient, to relay insurance referral and/or precertification
Assist other staff as needed. Other related duties as
PHYSICIAL AND SENSORY REQUIREMENTS:
The employee should be comfortable sitting up to eight hours a
day. Continually using fingers for typing and writing. Routine use
of upper extremities. Stoop, bend and reach above shoulder level
regularly. Vision must be correctable to 20/20 and hearing must be
in the normal range for telephone calls. Position also requires
viewing computer screens and typing for long periods of time.
POTENTIAL ON-THE-JOB RISKS:
Repetitive motion injury of the wrist due to frequent computer
use (adaptive modification of keyboard available).
Employees who work in patient care areas where they may have
potential exposure to patients with suspected or proven
tuberculosis (TB) must have the ability to wear a particulate
respirator and be fit-tested in compliance with the current
recommendations from the CDC (enforced by OSHA) or must provide
physician documentation as to the inability to wear a particulate
SPECIFIC PROTECTIVE EQUIPMENT AVAILABLE: NONE
MOST COMPLEX DUTY:
* Ability to maintain a working knowledge of insurance and
precertification requirements * Reviewing a patient's electronic
chart for information that is needed when requesting
precertification. * Ability to communicate effectively with
physicians/providers, team members and patients. * Ability to
prioritize work in an environment of constant change while meeting
the needs of the office.
SUPERVISION (RECEIVED BY AND/OR GIVEN TO):
The employee must possess the ability to communicate effectively
and appropriately with patients, insurance companies,
physicians/providers and team members at both Southside Medical
Center and Family Medicine - Easton Avenue. The employee must be
assertive and pleasant in order to gather accurate and complete
data and must be able to convey information to patients in a way
that they can understand. The employee must know when it is
appropriate to listen and must be able to remain calm, tactful and
even-tempered in a variety of situations. The employee will
communicate with the Southside Practice Administrator and with the
Easton Avenue Practice Administrator effectively; and will relay
information pertaining to personal absences (ex: PTO, Sick Days) to
both administrators so that they are aware that other arrangements
will need to be made to ensure that the referral and
precertification work is completed by other team members at their
The employee must demonstrate a positive attitude in keeping
with PCRAFT values. The employee must be customer service driven,
motivated and ambitious; and should be able to enjoy working with
people while finding it necessary, at times, to collaborate with
peers in order to solve problems. The employee must possess problem
solving and multitasking abilities in order to fulfill the
requirements of this position.
EDUCATION: High School diploma required.
TRAINING AND EXPERIENCE: Previous precertification experience
helpful. Medical coding and terminology experience preferred.
WORK SCHEDULE: Day, middle or night shift with varying hours
based on the needs of the department. Travel to satellite offices
may be necessary.
Please complete your application using your full legal name and
current home address. Be sure to include employment history for the
past seven (7) years, including your present employer.
Additionally, you are encouraged to upload a current resume,
including all work history, education, and/or certifications and
licenses, if applicable. It is highly recommended that you create a
profile at the conclusion of submitting your first application.
Thank you for your interest in St. Luke's!!
St. Luke's University Health Network is an Equal Opportunity