PreCertification Specialist Passport Health Communications
THIS JOB HAS EXPIRED Exempt/Non-Exempt:Exempt
Benefits:Full Comprehensive Benefits Package
Employment Type:Full Time
Description:Passport Health Communications, Inc., a nationally recognized pioneer developing innovative solutions for the healthcare industry and one of Healthcare Informatics Top 100 Healthcare Companies, is seeking a PreCertification Specialist for our subsidiary office, Healthworks, located in Wayne, PA.
Under general direction, the Precertification Specialist is responsible for the accurate representation of payor specific guidelines from any source. The PreCertification Specialist is responsible not only for all credential and script maintenance and documentation but also any other information extracted and utilized in the automated precertification process.
Duties:?Works collaboratively with the Director and all development and content/QA staff to ensure all precertification scripts for payor specific websites are accurate and complete.
?Maintains a working knowledge of precertification requirements by payor. Obtains and uses payor specific websites
?Contacts payors directly and works with them to obtain/refresh credentials for any client?s payor as needed
?Assists with review and research of payers requiring additional detail for scripting
?Extracts information from resources, translating to form appropriate outcome
?QA of precertification product to include not only completed scripts but also any product functionality for accuracy with representative documentation to Director
?May make recommendations and assist with the mapping of insurances to the correct contracted payor
?Assists Director with collecting necessary information for Clinical Orders products from clients including the associated workflow pattern for definition of work queues
?Updates and maintains patient tracker database by client site
?Updates and maintains credential database for all OrderRite sites and scripts
?Performs scheduled collection of required HTML extracts for precertification submissions
?Reviews submissions of requested payors by site forwarded by implementation; reviews recommends adjustments when necessary
?Completes in-depth, reviews of issues forwarded by Technical Support. Composes responses and discusses with clients when necessary.
?Create and maintain document/database of product enhancements requests from clients.
?Maintains record/database of all production scripts as utilized per client
?Notifies Director of issues and concerns that impact client satisfaction.
Other Duties as Required.
Qualifications:?2-5 years? experience in a healthcare precertification role
?Experience working with online insurance portals.
Thorough knowledge of the healthcare revenue cycle required
Working knowledge of insurance benefit terminology and precertification guidelines
?Ability to multitask, prioritize, and maintain organization in a high volume environment
?Self-driven, results-oriented with a positive outlook, and a clear focus on high quality productiveness
?Ability to maintain effective working relationships is essential
?Standard English grammar/usage and proper telephone etiquette
Equivalent combination of education and experience may be considered.
?Knowledge of Medical Terminology and procedural coding systems a plus
||Wayne, PA |
THIS JOB HAS EXPIRED