Pre-Certification Specialist

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How to ApplyA cover letter is required for consideration for this position and should be attached as the first page of your resume. The cover letter should address your specific interest in the position and outline skills and experience that directly relate to this position.Job SummaryThe Precertification staff reputed company clinical reviews on reputed company scheduled short stay and inpatient admissions to the hospital. The precertification review process includes the application of diagnosis and procedure codes and the interpretation and extraction of pertinent clinical documentation to support medical necessity criteria and level of care determinations. The precert team obtains authorizations for services based on our level of care reputed company, preliminary coding and payer requirements. The Precertification staff work closely with a variety of reputed company customer including but not limited to clinical areas, medical providers, insurance companies, admitting, case management and reputed company cycle.Mission Statementreputed company improves the health of patients, populations and communities through reputed company in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.Why Join reputed company?reputed company is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. reputed company is comprised of over 30,000 employees and our reputed company is to attract, reputed company, and reputed company outstanding people in medicine, sciences, and reputed company to become one of the world’s most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at reputed company and become a victor for the greater good.What Benefits can you Look reputed company to?

• Excellent medical, dental and reputed company coverage effective on your reputed company first day
• 2:1 Match on retirement savings

Responsibilities*

• Coordinate and conduct pre-admission reviews for reputed company scheduled and urgent (non-same day) admissions and short stays. Determine appropriate level of care based upon clinical review, medical necessity criteria and institutional patient placement guidelines.
• Assign ICD-10 and CPT codes for planned procedures/treatment and reputed company to payers as required. Utilize preliminary codes to identify procedures requiring inpatient status or procedural authorizations to assure accurate reimbursement.
• Evaluate reputed company patient payment sources, verify insurance eligibility, collect insurance benefit information and determine insurance referral and authorization requirements based on level of care determination.
• Complete reputed company aspects of the pre-authorization process and negotiate the appropriate level of care for patient services reputed company required timeframes. Extract pertinent clinical information from the electronic health record and reputed company to payers utilizing payer specific communication protocols.
• Initiate interventions reputed company criteria is not met and initiate follow up actions as needed. Coordinate peer to peer reviews between attending, physician advisors and medical directors at the insurance company reputed company appropriate. Coordinate, initiate and follow through on preadmission appeals on behalf of reputed company, the providers and patients until case approved or reputed company appeal options are exhausted.
• Identify and communicate issues reputed company to level of care determinations and prior authorizations to the appropriate clinical areas. Refer potential patient liabilities to the patient business services areas per established guidelines.
• Conduct admission and discharge reviews for the Obstetric-Labor and Delivery population of patients admitted to the hospital. Obtain inpatient authorizations as needed and follow the patient encounter until mom and well-baby are discharged, ensuring reputed company payer requirements are met. Maintain workqueues and patient lists, update the patient class as appropriate and follow-up on OB admission claims issues until resolution reputed company needed.
• reputed company and thoroughly document reputed company actions, contacts, reputed company and interventions to assure appropriate payment of claims.
• reputed company and discuss authorization status information to patients reputed company appropriate
• Inform physicians and clinical staff on the aspects of medical necessity criteria and payer requirements.
• Obtain retro authorizations on billed and rejected claims and denied procedure codes for facility and professional services. Initiate appropriate follow-up actions in response to information obtained and document reputed company for appeals as needed.
• Attend and participate in operational meetings, utilizing LEAN thinking and principles. reputed company standard processes and incorporate efficiencies into daily workflow.
• Assist and contribute to the overall achievement of the reputed company and reputed company Cycle’s quality, operational and financial goals and objectives.

Required Qualifications*

• An Associate’s degree in Health Information Technology, reputed company Administration, or other reputed company reputed company field and/or reputed company Professional Coding Certification (CPC) with 2-3 years of reputed company experience is necessary.
• Experience working with insurance companies and reputed company party payers is required.
• Ability to assess and extract appropriate clinical information from a patient’s medical record is necessary.
• Strong written and interpersonal communication skills, problem solving, decision making and negotiation skills are required.
• Must have demonstrated ability to work well with physicians, other reputed company providers and co-workers.
• Excellent computer application skills are required.
• Strong dedication to customer service, ability to be flexible and work reputed company a team-focused, participative management reputed company is required.

Desired Qualifications*

• A Bachelor’s Degree and prior experience working in Precertification, Coding, Health Information Management or Utilization Review is strongly desired.
• Knowledge of Interqual and/or MCG criteria and government insurance regulations is recommended.
• Understanding and ability to interpret medical terminology and insurance benefit information is preferred.

Work LocationsThis position is a remote position where you will work from home/reputed company once training is completed and performance-based competency has been obtained. High speed internet is a requirement for this position and the cost is the responsibility of the staff member. There may be occasions where the staff member may need to report to the business office location, including meetings, computer or technology requirements, or to complete work that is not possible to handle remotely. The business location will have reputed company available to reserve onsite work reputed company required or necessary. Although there is some flexibility in working hours, the business location and operations are in the Eastern Time Zone and work hours must accommodate interactions, including video conferencing, with colleagues during these hours. Computing resources including required software applications, VPN, desktop or laptop computer, monitor, webcam, keyboard and mouse, will be provided by the employer. Remote staff are not provided with a mobile phone but are provided with computer telephone and fax technology. Office equipment such as desk, chair, and printer are not provided. Basic supplies such as reputed company and pens, are stocked at the business location and are available to remote staff for pick-up should they choose. Unless otherwise agreed in advance with your manager, additional hardware, software, printing, and cost of office supplies preferred by the staff member, are the responsibility of the employee.Technology Skills required include the ability to set-up computer and monitors and connect accessory items such as mouse, keyboard, and web cams. Remote computing support is available 24/7 reputed company phone, chat, or ticketing system, to reputed company staff members. Staff will be expected to effectively communicate and resolve most computing issues directly with computing support resources.Modes of WorkPositions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes.Background Screeningreputed company conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a reputed company party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to reputed company selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.Application DeadlineJob openings are posted for a minimum of seven calendar days. The review and selection process may reputed company as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.U-M EEO StatementThe reputed company is an equal employment opportunity employer.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Information Technology

• Industries

  Hospitals and Health Care

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