Openings >> W/C Precertification Specialist/Self Pay Counselor Full Time
W/C Precertification Specialist/Self Pay Counselor Full Time
Summary
Title:W/C Precertification Specialist/Self Pay Counselor Full Time
ID:1791
Department:PRD
Location:Columbus, GA
Description
The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or protected veteran status. This company is a VEVRAA Federal Contractor.

Complete the precertification/prior authorization process by contacting Workers Compensation insurance companies/adjusters. Communicate the approval/denial of surgeries and/or tests effectively/timely to physicians and physicians’ staff.  Secondary focus on self-pay accounts receivable by contacting hospital/patient to obtain insurance information and/or direct collection of revenue from patient.

Position Responsibilities:
  • Responsible for obtaining precertification and prior authorization for patients covered by Workers Compensation scheduled for a surgical procedure and/or tests as ordered by physician
  • Responsible for obtaining all necessary information required to obtain precertification or prior authorization to include clinical dictation and test results
  • Provide accurate information to insurance companies based on test results, clinical dictation, etc.
  • Verify/re-verify insurance benefits and eligibility for each scheduled surgical procedure and/or test
  • Complete precertification and prior authorization process in a timely, efficient manner with respect to urgent requests
  • Review self-pay accounts receivable aged 60 days plus on a weekly basis
  • Self-pay AR is to be worked prior to collect status
  • Utilize hospital system for confirmation of insurance not appended to Athena demographic screen
  • Contact patient to discuss outstanding balances and/or collection of insurance information
  • Set payment plans as requested under specified guidelines for each entity
  • Process CC payments provided by patient/Insurance companies under appropriate entity on CC machine
  • Provide backup to Financial Counselor as needed
Experience: One year of medical insurance and medical terminology experience required. Computer skills required.
Education: High School Diploma or GED required.
Special Qualifications: Must be able to work independently and have a working knowledge of HIPAA.


 
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