PRE-CERTIFICATION SPECIAL
- POSITION SUMMARY
- The Pre-Certification Specialist cancer care services is responsible for obtaining insurance authorization and insurance benefit eligibility verification for patients at Trinity Health in a prompt and accurate manner. This position works collaboratively as part of the revenue cycle program to ensure oncology services are authorized based on insurance payer guidelines to minimize the reimbursement risks associated with providing care to patients to include oral chemotherapy. This position is responsible to work with Specialty Pharmacies representatives to support co-pay and compassionate use drug program opportunities for patients and to work with CancerCare staff and coding staff on appeals and/or denials when applicable.
- MINIMUM QUALIFICATIONS AND REQUIREMENTS
- Licenses and Certifications Required
- None
- Educational Requirements
- High School diploma or equivalent preferred.
- Experience Requirements
- Experience with third party payer billing regulations, reimbursement requirements, precertification, insurance eligibility verification, and/or utilization management is preferred.
- Working knowledge of CPT/ICD10 and medical terminology is preferred.
- Special Skills or Training Requirements
- Demonstrated advanced communication and interpersonal skills with all levels of internal and external customers.
- Self-directed, attention to detail.
- Computer experience.
- Ability to navigate numerous websites for eligibility and prior authorization.
- Working knowledge of Microsoft Office Suite applications including Outlook, Word and Excel.
- Excellent written and oral communication skills.
- Ability to handle high workload volume.
- Must be flexible and demonstrate ability to be adaptable.
- Licenses and Certifications Required