EMC Job Opportunities

"Work and live in a community that appreciates you. Practice your profession where it matters. Lower cost of living, higher quality of life. Emanuel Medical Center wants you!"

Emanuel Medical Center, P.O. Box 879, 117 Kite Road, Swainsboro, GA 30401
Fax: 478-289-1385 Email: humanresources@remove-thisemanuelmedical.org

QUALIFIED CANDIDATES’ APPLICATIONS WILL BE FORWARDED TO THE APPROPRIATE MANAGER. APPLICATIONS SUBMITTED FOR POSITIONS OTHER THAN THOSE POSTED WILL NOT BE CONSIDERED.

#536 Precert Specialist

Job Type
Fulltime
Contract Type
Contract
Job Description

Pre-certification Specialist

 

The Pre-Certification Specialist ensures the effective and efficient use of services, monitors appropriateness and medical necessity and provides necessary information for authorization of services for physician practices.

 

 

Duties and Responsibilities:

 

  1. Responsible for tracking, obtaining and communicating pre-authorizations/pre-certifications as needed per insurance company requirements in a timely manner.
  1. Responsible for obtaining complete and accurate insurance information, benefit verifications, accurately interpreting benefit plans and investigating pertinent details.
  1. Track a significant amount of data and information, preparing and producing meaningful reports and information.
  1. Assists with the effective management of all incoming procedure pre-certification needs and effective follow-through of the pre-certifications.
  1. Assist in the development, organization and maintenance of role specific documents, policies and tools.
  1. Provides direct support for physicians when dealing with pre-certification issues.
  1. Provides all authorization and pre-certifications to physician and physician staff in a timely manner.
  1. Communicates with patients and providers about authorization denials, appeals or other issues.
  1. Communicates as needed with physicians/clinicians and other staff about any patient concerns/issues related to scheduling.
  1. Facilitates communication as needed between patients, insurance carriers, clinics physicians and referring physicians.
Job Requirements

Requirements:

 

  • Minimum three years experience in processing healthcare prior-authorizations/pre-certifications and referrals
  • Understands requirements for internal and external referrals and pre-certifications.
  • Understands the concept of PCP and referral protocols as defined by insurance carriers
  • Excellent communication and customer service skills
  • Demonstrates a commitment to service, organization values and professionalism       through appropriate conduct and demeanor at all times.
  • Strong interpersonal skills
  • Ability to adapt to changing workflows, processes and work queues
  • Strong time management skills, the ability to plan, prioritize and complete tasks within the expected time line.