<p>Current Employees: If you are currently employed at SOMC please log into UKG Pro to use the internal application process.</p> <p>Department: Utilization Review</p> <p>Shift/Schedule: Full Time (40 hrs/wk), Remote</p> <p>GENERAL SUMMARY</p> <p>Works under the supervision of the Supervisor of Central Scheduling. The Pre-Cert/Insurance Authorization Specialist primary job functions are to perform professional orderly, efficient insurance verification and pre-cert for outpatient procedures and same day surgery. The Pre-Cert/Insurance Authorization Specialist responsibilities are to verify insurance coverage/eligibility, obtain pre-certification/prior authorization, benefit information through online systems and calling the insurance companies. Is responsible for notifying provider office when a procedure is pending to have the patient reschedule. Is responsible for safeguarding the public relations and confidentiality of the hospital and its records by consistent professional conduct. Performs other duties as assigned.</p> <p>QUALIFICATIONS</p> <p>Education:</p> <ul> <li>High School Diploma or successful completion of an equivalent High School Exam Required </li></ul> <p>Licensure:</p> <ul> <li>None </li></ul> <p>Experience:</p> <ul> <li>Six to twelve months of related work or hospital billing experience required </li><li>Experience with computer preferred </li><li>Insurance knowledge preferred </li><li>Medical terminology preferred </li><li>Scheduling knowledge preferred </li><li>Knowledge of CPT/ICD 10 codes preferred </li></ul> <p>JOB SPECIFIC DUTIES AND PERFORMANCE EXPECTATIONS</p> <p>The following is a summary of the major job duties of this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.</p> <ul> <li>Collects accurate financial, demographic and clinical data involving interaction with patients, physicians, insurance companies and outside agencies to meet the registration/precert standard in all systems used by Registration/Central Scheduling. </li><li>Verifies coverage and eligibility, obtains Pre-certifications/Prior Authorizations on MRI, CAT Scan, Cardiac Testing Home Care and or any Outpatient test, oupatient surgeries, and procedures that require </li><li>Collects and maintains various department records, logs and statistical date timely and accurately as identified by the Central Scheduling Supervisor. Documents all correspondence telephone calls and account activity. </li><li>Assists in training and education of employees. </li><li>Obtain clinical notes for outpatient testing and outpatient surgery for insurance companies requirements </li><li>Reviews and works reports/work list for financial reimbursement </li><li>Reviews the Surgery Schedule for authorization and follows up with the physician office if it is not notated in the system with the required time </li><li>Performs other duties as assigned </li></ul> <p>Thank you for your interest in Southern Ohio Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status.</p> <p>Southern Ohio Medical Center is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, disability, ethnicity, gender identity, or expression, genetic information, military status, national origin, race, religion, sex, gender, sexual orientation, pregnancy, protected veteran status or any other basis under the law.</p>