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Pre-Certification Specialist Pediatric Specialty Center

Company: St. Luke's University Health Network
Location: Center Valley
Posted on: September 20, 2022

Job Description:

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.Obtains precertification/preauthorization from insurance companies prior to procedure or testing utilizing an online application or contacting the insurance company by telephone. 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 and the patient. Maintains online log of patient's requiring precertification. Maintains working knowledge of all online precertification applications. Demonstrates competency in assigned areas of responsibility. Responds to written and telephone inquiries from patients, insurance carriers and facilities regarding planned services. Maintains detailed knowledge of computer software systems as it relates to job functions.Takes an active role in facilitating team approach to functions within the department:

  • Attends departmental meetings
  • Actively participates as a team member in resolution of problems as they are identified
  • Analyzes current procedures, bringing suggestions for improvement to the attention of team members and Practice Administrator consideration
  • Document authorizations in medical record and provide to appropriate sources.Proficient in Electronic medical record program used in office. Maintains confidentiality of all materials handled within the Network/ Entity as well as the proper release of information. - Complies with Network and departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements.Demonstrates/models the Network's Service Excellence Standards of Performance in interactions with all customers (internal and external). - - Demonstrates Performance Improvement in the following areas as appropriate: Clinical Care/Outcomes, Customer/Service Improvement, Operational System/Process, and Safety.Demonstrates financial responsibility and accountability through the effective and efficient use of resources in daily procedures, processes, and practices. Complies with Network and departmental policies regarding attendance and dress code. - Demonstrates competency in the assessment, range of treatment, knowledge of growth and development and communication appropriate to the age of the patient treated. Contacts Central Scheduling, Patient Access Department, and patient, to relay precertification information.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!!

Keywords: St. Luke's University Health Network, Bethlehem , Pre-Certification Specialist Pediatric Specialty Center, Other , Center Valley, Pennsylvania

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