Job Description
M-F 830a-5p
WOOSTER COMMUNITY HOSPITAL JOB DESCRIPTION
Insurance Precert Representative
MAIN FUNCTION:
Protects hospital payments for inpatient admissions and outpatient services requiring precertification. Ensures all scheduled outpatient services requiring prior authorization/precertification have the correct and appropriate authorizations prior to services being rendered.
RESPONSIBLE TO: The Director and Manager of Patient Access
MUST HAVE REQUIREMENTS:
Experience working in a physician’s office or hospital setting with third party payers to obtain authorization for hospital services
Proficient in medical terminology
Strong organizational skills and demonstrated ability to work independently.
Current computer or Meditech skills
Demonstrated effective interpersonal and oral communications skills
No written disciplinary action within the last 12 months.
Ability to utilize internet and other technology
PREFERRED ATTRIBUTES:
2 years previous experience in a physician office or hospital setting
Post High School education in medical office skills
POSITION EXPECTATIONS:
* Receives notification of services/testing scheduled to be performed at the hospital
* Effectively navigates payer websites to verify insurance benefits and obtain necessary pre-certs per payer guidelines
* Verifies completion of all needed pre-certs for outpatient procedures
* Maintains a professional relationship with the physician’s and their office staff
* Communicates effectively with other departments all information necessary to complete the precertification process
* Functions successfully in a team-oriented work environment
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