Contacts insurance companies and other third party payers to determine pre-certification, pre-authorization and/or medical necessity requirements for basic and moderately complex hospital outpatient visits. Obtains pre-certification or pre-authorization prior to the scheduled service being performed. Liaisons with physicians and physician office staff when needed to obtain additional demographic, insurance or clinical information. Notifies the payer of admission if required.

Contacts insurance companies and other third party payers to determine pre-certification, pre-authorization and/or medical necessity requirements for basic and moderately complex hospital outpatient visits. Obtains pre-certification or pre-authorization prior to the scheduled service being performed. Liaisons with physicians and physician office staff when needed to obtain additional demographic, insurance or clinical information. Notifies the payer of admission if required.

Education

• H.S. Diploma or General Education Degree (GED) Required


• Bachelor’s Degree from a recognized college or university Preferred

Work Experience

• 2 years exp in Healthcare Revenue Cycle or related healthcare experience Required


• 3 years of previous related healthcare Revenue Cycle experience within precertification/authorization experience Preferred

Licenses and Certifications

• None Required

Additional Licenses and Certifications

• Certification with Healthcare Financial Management Association, or Certified Revenue Cycle Representative Preferred


• Completion of medical coder training program is Preferred

Piedmont Healthcare