Wheaton Franciscan Healthcare

Central Precertification Rep II

Location: West Allis, WI

Knowledge and experience in coverage practices, terminology, and requirements for referrals and authorization/pre-certification used by third party payers, especially HMO's and PPO's.
Coordinates information from the patient, physicians and office staff, clinicians, and employers as needed to complete the authorization process.
Communicates situations projected to result in a significant non-covered balance to patient and business office.
Obtains pre-certification and concurrent review information and communicates to the appropriate hospital departments and payer representatives.
Provides notice of admission to appropriate payers.
Communicates corrected information and acts as a resource to Patient Access, Care Management, and others in regard to contract guidelines and pre-certification requirements. Notifies Care Management staff when medical review is required.
Reviews and analyzes financial information from third party payer systems and communicates that information to the business office and appropriate servicing department.
Initiates authorization/certification
Utilizes resources available and documents pertinent authorization/certification detail to appropriate software system.
Maintains a strong customer focus while working collaboratively within a team to meet multiple demands, patient needs and shift coverage.
Maintains confidentiality of all information.

Skills/Requirements

Medical terminology-required
Proficient in use of personal computer,
Demonstrated ability to work independently in a fast paced environment with constant interruptions.
Customer service orientated with strong interpersonal skills and phone etiquette. Ability to relate effectively to a variety of customers in a professional and courteous manner.
Sound reading and grammar skills, as well as demonstrated analytical ability to collect and interpret insurance and contract information.
Demonstrates analytical ability to identify financial viability of patients via computer software or questions to the patient.
Excellent organizational skills
Knowledge and experience in coverage practices, terminology, and requirements for referrals and authorization/pre-certification used by third party payers, especially HMO's and PPO's.
Demonstrated openness to continued personal and professional development.
Must have effective vision with ability to distinguish colors on a computer screen, as well as manual dexterity for fine manipulation of keyboard and mouse use.
Ability to speak and hear clearly, to allow for effective communication from various customers with frequent interruptions.
Cognitive ability to allow for organizing multiple concepts and information, analyzing data, and basic problems.