Precertification Representative Lead

Position Summary:

Surgery Pre-Certification Lead Counselor is responsible for covering the work on the desk of any pre-certification counselor during any absence. Lead will be responsible for handling their own volume of work along with monitoring the staff work. This will include any stat surgeries and follow up on all pending paperwork. Lead will be available to other Pre-cert Counselors as a problem solver for questions or issues arising with their daily work. The Pre-Cert Counselors will work in the office multiple days a work.

 

Qualifications:

Experience with insurance verification, medical terminology and CPT, ICD9 coding. Ability to calculate co-ins co-pays for collection from patient. Basic computer skills and knowledge, including Athena, WORD, and EXCEL programs. Two years experience with surgery authorizations and pre-certifications.

 

Key Responsibilities:

• Lead work effectively and maintain excellent communication with other Management Team members.
• Lead will ensure retro-authorization cases are worked equal to a stat and are completed daily
• Lead will ensure that the ER surgeries are worked equally to a stat and are completed daily.
• Lead will monitor effective denial management of surgical cases.
• Lead will oversee the training of the Pre-Cert Counselors in office for 6 months.
• Lead will be responsible for running the daily Athena reporting.
• Lead is expected to work in the office several days a week.
• Lead will be responsible for assisting the pre-cert counselor that has temporary influx of workload.
• Lead will be assigned case volume to work daily as a representative.
• Will distribution work to other pre-certification counselors, as necessary.
• Lead will communicate with supervisor any problems or issues of concern within the department.
• Lead will ensure that cases are pre-certed out at least 14 days from the current date of services.
•  Lead will work with the Pre-cert Supervisor to training department staff of medical necessity for each procedure.
• Lead will cross train and always cover other sub-specialty lead job duties.
• Precert Lead will help Pre-cert Collectors with collections when necessary.
• Lead will ensure third party companies are working surgical procedures timely and accurately.
• All other duties as assigned.