Member Certification Specialist jobs in Louisiana

Description

POSITION: Pre-Certification Specialist 

REPORTS TO: Manager, Pre-Certification

JOB STATUS: Full Time – 8:00 a.m. – 5:00 p.m.

General duties: The duties for this position include obtaining eligible benefits and pre-authorization for procedures from insurance companies. Communicating financial responsibility to the patient prior to scheduled services. Clerical duties and other duties are assigned by the manager according to policies and procedures and the mission of Louisiana Women’s Healthcare. 

Job responsibilities:

• Validate eligible benefits and obtain pre-authorization for medical services from insurance companies.
• Communicate with Patients their eligible benefits and financial responsibility for services.
• Communicate with Patient Account’s Department prior to patients’ arrival for services.
• Communicate with physician’s nursing team .
• Performs other work-related duties as required.      

 Knowledge:

1. Knowledge of HIPAA compliance
2. Knowledge of OSHA compliance
3. Knowledge of Pre-Authorization Process 
4. Knowledge of Medical Terminology 

Skills:

1. Computer skills and dexterity required for data entry.
2. Verbal and written communication skills to communicate with confidence with professionalism. 
3. Customer service – Provide a positive experience for the patient.
4. Ability to multi-task
5. Personable – have a pleasant personality and ability to remain calm in a stressful situation when speaking to patients regarding patients’ financial responsibility.

Abilities:

1. Ability to read, understand and follow oral and written policies and regulations. 
2. Ability to examine documents for accuracy and completeness
3. Ability to communicate clearly and concisely
4. Ability to establish and maintain effective working relationships 

Environmental/Working conditions: 

• Normal office environment.   
• Must be able to do prolonged sitting
• Must be able to work independent and as a team player

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

Requirements

Education and Background:

• High school graduate. Previous experience in the private physician setting, preferably OB/GYN office or Family Practice. EPIC computer literacy preferred. 

• Temperament:
• Prefers detail-oriented work. Ability to prioritize tasks. Willingness and ability to work in any areas of assigned responsibility.

• Physical Requirements:
• Manual dexterity for data entry on the computer. Ability to speak in a clearly understandable manner. Visual ability to review computer reports. Requires sitting and standing associated with normal office environment. All duties to be performed with or without accommodation.

Office Citizenship Expectations

• Maintains appropriate, professional conduct and appearance at all times; follow office dress code consistently.
• Completes work in an established time frame; seeks appropriate tasks when primary tasks are completed or pace is slow.
• Demonstrates willingness to perform other duties to assist the team effort for the benefit of the patients, physicians and fellow employees.
• Demonstrates adaptability to expanded roles of the organization and changing environment.
• Consistently arrives at work on time and completes all tasks.
• When not in the office, arranges for coverage, or requests assistance to ensure assigned work is completed.
• Maintains work area in a professional, neat manner.

JOB STATUS:

This is a full time, non-exempt position.