Description:
RESPONSIBLE FOR:
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 service being performed. Liaisons with physicians and physician office staff including peer to peer when needed to obtain additional demographic, insurance or clinical information. Provides clinical support to Patient Connection Center Authorization and Prep Associates or as needed.
Qualifications:
MINIMUM EDUCATION REQUIRED:
Graduate of a nursing program.
MINIMUM EXPERIENCE REQUIRED:
Two (2) years of related experience in healthcare with precertification/authorization experience.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
Current State of Georgia Registered Nurse license.
ADDITIONAL QUALIFICATIONS:
Three (3) years of previous related experience, preferably with precertification/authorization experience, preferred.
Bachelors degree from a recognized college or university preferred.
Certification with Healthcare Financial Management Association or Certified Revenue Cycle Representative is preferred.
Prior Epic experience is desired.
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