Job Description

Pre-Certification Specialist

- Southwoods Executive Centre





Southwoods Health is hiring a Pre-Certification Specialist to work in our Authorizations Department in Boardman. The Pre-Certification Specialist will request and obtain authorizations for procedures and imaging ordered by Southwoods Health physicians.

Essential Duties:

Respond promptly to referral source requests for information, supporting documentation, or other report needs Obtain accurate and detailed information to begin investigating sources for payment and gather patient information Obtain authorization from payer sources to begin services. Assist in resolving insurance issues, re-authorization, and eligibility issues Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed Facilitate follow-up regarding ongoing services, eligibility, and authorization Communicate payer verification or benefit issues Record insurance information to maintain data and communicate insurance information to pertinent staff Maintain confidentiality of patient information Independently maintain and work from the electronic medical record and additional databases Obtain pre-certification number from physician's office if applicable Assist in the development, organization, and maintenance of role specific documents, policies, and tools Follow all federal, state, and regulatory guidelines to maintain compliance Ensure all processes at responsible physician practice maintains compliance with all regulatory agencies Perform other duties as assigned

Qualifications:

Training or courses in business office activities, computer skills, and medical terminology Effective communication skills, ability to problem solve, and great attention to detail Insurance Verification experience Minimum of 2 years' experience pre-authorizing medical procedure and imaging exams across modality and specialty (FP or IM office experience a plus)






Full-time. Monday-Friday 8:30am-5:00pm.





At Southwoods, it's not just about the treatment, but how you're treated. #SWH

www.southwoodshealth.com