Full Time, Benefits Eligible
The moment you walk through our doors, you can feel it. When you meet one of our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it, too. Welcome to Nationwide Children’s Hospital, where Passion Meets Purpose.
Here, Everyone Matters. We’re 12,000 strong. And it takes every single one of us to improve the lives of the kids we care for, and the kids from around the world we’ll never even meet. Kids who are living healthier, fuller lives because of the knowledge we share. We know it takes a Collaborative Culture to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere.
Ask anyone with a Nationwide Children’s badge what they do for a living. They’ll tell you it’s More Than a Job. It’s a calling. It’s a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere.
Nationwide Children’s Hospital. A Place to Be Proud.
This position is responsible for the verification of benefits, requesting initial authorization, documentation of benefit information, and meeting provider’s referral requirements to ensure that optimum payment is made to the hospital and providers. This position is responsible for timely and accurate documentation of commercial, HMO’s and PPO’s insurance benefit information in accordance with agency policy and the guidelines set forth in the client’s contract.The Pre-Cert Specialist will provide the services mentioned above to its customers, including but not limited to clinics,
providers, patients, managed care department, and the patient accounts department.
1. Contact insurance companies to obtain and verify benefit information, document all benefit information, and meet payer’s referral requirements to ensure that optimum payment to the hospital and providers will be satisfied.
2. Set-up and maintain detailed files for all insurance eligible clients.
3. Answer any correspondence regarding benefit information and prior authorization in a timely manner.
4. Obtain insurance prior authorization as needed and document the verification of benefits and prior authorizations in Epic and Avatar.
5. Assists with the retrospective review of records for patients who have insurance changes that impact the authorization.
6. Maintains knowledge of The Joint Commission, Medicaid, Medicare, and other third-party payer standards and requirements.
7. Assists in identifying self-pay patients and referring them to financial assistance when applicable.
8. Establishes and maintains open communication with all departments that Patient Access and Clinical staff interacts with.
9. Participates in department and interdepartmental meetings to promote knowledge, troubleshoot, and resolve issues related to benefits or authorizations.
10. Shows respect for the authority of others, including but not limited to supervisor, manager, physicians, and nurses.
11. Displays positive attitude and discusses decisions or policies in a positive, problem-solving way.
12. Performs other related duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
1. High school graduate, Associate Degree preferred. Knowledge of filing, PC operation, Lab and Radiology order entry and office skills.
2. One year previous health care clinical experience preferred but not required.
3. Must be able to answer multiple telephone lines, file documents, pull medical charts and operate PC.
4. Must have Ohio driver’s license and be able to drive to and from all the Close to Home Physician Care Centers, as staffing needs change. (for Float Staff only that are required to drive during working hours)
MINIMUM PHYSICAL REQUIREMENTS
Must be able to see, hear, stand, walk, speak, read and perform manual tasks with or without accommodation, and care for oneself with little or no difficulty. Sitting Constantly (67-100%) Talking on phone/in person Constantly (67-100%) Typing on keyboard Constantly (67-100%) Standing/walking/reaching/bending Occasionally (0-33%)
The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individual so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under his/her supervision. EOE M/F/Disability/Vet