Pre-Certification Team Lead - Dean McGee Eye Institute - Oklahoma Health Center

Position Title:

Pre-Certification Team Lead - Dean McGee Eye Institute - Oklahoma Health Center

Department:

General Overhead

Job Description:

General Description: Responsible for timely and accurate pre-registration and insurance verification. Accurately interprets managed care contracts. Provides assistance to staff level employees as necessary to ensure compliance with department policies and procedures. Assists manager with staffing, report reconciliation, QA processes, and other duties as assigned.

Essential Responsibilities:

• Perform pre-registration and insurance verification according to SSC standards and guidelines
• Document benefits verification and pre-certification in Meditech Standard Customer Defined screens
• Contact physician and/or insurance company to resolve issues regarding prior authorization or referral forms
• Assign Iplans accurately
• Perform electronic eligibility confirmation when applicable and document results
• Research Patient Visit History to ensure compliance with the Medicare 72 hour rule per SSC standards and guidelines
• Complete Medicare Secondary Payor Questionnaire as applicable for retention in Abstracting module
• Calculate patient cost share and be prepared to collect via phone or make payment arrangement per SSC standards and guidelines
• Contact patient via phone (with as much advance notice as possible, preferably 48 hours prior to date of service) to confirm or obtain missing demographic information, quote/collect patient cost share, and instruct patient on where to present at time of appointment
• Receive and record payments from patient for services rendered per SSC standards and guidelines
• Utilize appropriate communication system to facilitate communication with facility PTAC and other departments as required
• Perform insurance verification and pre-certification follow up for prior day’s walk in admissions/registrations and account status changes by assigned facility per SSC standards and guidelines
• Communicates with hospital based Case Manager as necessary to ensure prompt resolution of pre-existing, non- covered, and re-certification issues per SSC standards and guidelines
• Utilize Meditech account notes and the Artiva system as approp