What are the responsibilities and job description for the PRECERT COORD OUTPATIENT position at Covenant Health?
Overview
Pre-Certification Coordinator, Outpatient
Full Time, 80 Hours Per Pay Period, Day Shift
Parkwest Overview:
Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer.
Parkwest is Covenant Health’s and West Knoxville’s premier medical facility and a top-performing heart hospital, offering our patients world-class treatment with all the convenience and warmth of home.
In addition to providing the area’s leading cardiac services, Parkwest has been nationally recognized for award-winning care throughout our facility. For 2020-21, Parkwest received recognition from U.S. News & World Report as one of the “Top 10” hospitals in Tennessee.
Knoxville located in East Tennessee is the third largest in the state, well-known for its proximity to the Great Smoky Mountains National Park, and is the home of the University of Tennessee. Go Vols! Living in Knoxville means experiencing all four seasons. Best of all, each of them is pretty mild!
Combine all that with the abundant natural beauty of the surrounding mountains, and you have a city that truly offers something for everyone. Knoxville has a vibrant arts culture, seasonal festivals, top-notch foodie and incredible outdoor recreation. It’s a perfect blend of big-city amenities and Southern charm.
Position Summary:
Assures payment from outpatients’ third party insurer by meeting all precertification requirements and by verification of patients’ insurance coverage. Establishes controls so that patients understand and receive accurate information on their patient liability.
Recruiter: Jason Shubert || jshuber1@covhlth.com || 865-374-5393
Responsibilities
- Precertifies outpatient services in compliance with regulatory/insurance requirements.
- Verifies with insurance company the nature and extent of patients’ insurance coverage.
- Follows-up on all claim denials for outpatient services. Determines the cause of denial, aggressively challenges wrongful denials and works with appropriate parties on resolutions.
- Assists off-site providers with procedural issues related to proper pre-certification and insurance verification requirements. Provides training to these locations as regulations/insurance requirement change and as employee turnover occurs.
- Participates with clinical, financial and utilization review departments to address opportunities to improve overall collections and cash flow.
- Responsible for automation requests that will enhance efficient collection of monies due the hospital. Able to develop format layout for programming needs.
- Analyzes data for opportunities to achieve improved collections, enhance relations with insurance companies and physician practices, and improve workflow related to outpatients.
- Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
- Performs other duties as assigned.
Qualifications
Minimum Education:
None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED. Preference may be given to individuals possessing a HS diploma or GED.
Minimum Experience:
Experience in outpatient registration. Will consider LPN with two years’ experience or individuals with inpatient pre-certification and insurance verification experience. Basic Medical terminology knowledge and prior pre-authorization experience preferred.
Licensure Requirement:
None
