Overview

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.

Responsibilities

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.

Qualifications

Education H.S. Diploma or General Education Degree (GED) Required Bachelor’s Degree from a recognized college or university Preferred Completion of medical coder training program Preferred Work Experience 2 years in Healthcare Revenue Cycle or related healthcare experience Required 3 years related healthcare Revenue Cycle experience within precertification/authorization Preferred Licenses and Certifications None Required Certification with Healthcare Financial Management Association Preferred Certified Revenue Cycle Representative Preferred Business Unit : Company Name Piedmont Healthcare Corporate