AspenRecruiter
the smart solution for Aspen jobs

Pre-Certification Specialist of Outpatient Clinics

Company: Aspen Valley Hospital
Location: Aspen
Posted on: September 10, 2018

Job Description:

The Pre-Cert staff is responsible for complete and accurate estimates, pre-authorizations and pre-certifications. This includes the proper and accurate completion of required insurance benefits, authorizations and waivers as well as patient estimates, claim authorization and insurance submission information. They must be familiar and compliant with all insurance contracts, Medicare and Medicaid regulations as well as with Aspen Valley Hospital (AVH) and its clinics compliance requirements, policies, rules and regulations. The Pre-Certification staff practices exceptional customer service and professionalism. They must act as a liaison between the free standing clinics, Hospital departments, staff, physician offices and the patient to effectively coordinate scheduling of tests and procedures. They are responsible for the pre-authorization function to assure accurate and timely payer information and fiscal responsibility. They are responsible for communicating to the patient any issues that may affect their procedure not being covered, for any reason. The Pre-Certification staff's daily responsibilities are directed by the Patient Access Director. ESSENTIAL FUNCTIONS 50% I ESSENTIAL JOB DUTIES Performs accurate pre-certification using thorough interview techniques to ensure that information is 100% complete. Ensures that all compliance requirements have been met, and the registration is properly created and/or updated for anticipated billing. Proper and accurate completion of required insurance benefits, authorizations and waivers as well as patient estimates, claim authorization and insurance submission information. Responsible for the pre-authorization function to assure accurate and timely payer information and fiscal responsibility. They are responsible for communicating to the patient any issues that may affect their procedure not being covered, for any reason. II SERVICE EXCELLENCE/CUSTOMER SERVICE Demonstrates purposeful service excellence through exceeding patient and coworker expectations. Represents the clinics/hospital as a dedicated, courteous, and responsive employee III COMPLIANCE WITH RULES, REGULATIONS AND POLICIES Records pertinent documentation in accordance with regulatory requirements, professional standards and hospital/clinics policy. Adheres to federal, state and hospital/clinics rules and regulations concerning HIPAA privacy and security. Follows Hospital compliance plan and policies, including the Code of Conduct. Participates in required training for compliance related activities (HIPAA, Compliance, Patient Safety, TJC, etc.) IV UNIT SPECIFIC DUTIES & RESPONSIBILITIES / DAY TO DAY OPERATIONS 100% correct pre-certification, verifying all patient insurance information, and insurance verifications, Understand and complies with all Clinics patient confidentiality, Advance Directives, ABN's and Insurance waivers. 100% correct pre-admission data that includes review of type of account, correct procedure, duplications of registration of M#, subscriber errors, and correct patient estimation. Fiscal responsibility that includes reviewing and competing ABN's, insurance waivers, and ensuring completed pre-certification as needed. They are responsible for communicating to the patient any issues that may affect their procedure not being covered, for any reason. Participates in department training and staff meetings. Reads daily summary reports and emails to ensure they are aware of any upcoming changes. V PROFESSIONALISM Demonstrates responsibility and accountability for own professional decision making and professional growth. Participates and contributes to departmental meetings and activities. POPULATION SPECIFIC CRITERIA No Rating Demonstrates the ability to assess and interact with customers of all ages, recognizing language and learning barriers, and technology challenges. VII CORE VALUES 50% Patient Centered: is passionate about patient care, creating positive impressions on a consistent basis and exceeding our patients' expectations. Exhibits courtesy and sensitivity to the needs of patients and their families, responds with a sense of urgency to patient problems, anticipates patient requirements, responds proactively and places the patient's safety above all else. Teamwork: works collaboratively with physicians and other staff and assists whenever possible. He/she openly shares information, provides feedback and participates in appropriate decision making as part of a team of healthcare professionals. Hospital and departmental objectives are placed ahead of individual agendas Respect for Others: actively listens to others, takes other opinions into account, and communicates openly and honestly. He/she demonstrates respect for others by being timely with communications, completion of tasks, and meeting attendance. The employee is respectful of all physicians, colleagues, patients, visitors, and other stakeholders Accountability: takes responsibility for his/her actions, abides by the hospital's guiding philosophies and policies, and follows through on commitments and physician orders. He/she provides complete and accurate information to the Physician and/or other members of the work team. takes personal pride and ownership in the quality of care and services provided to all internal and external customers Integrity: is truthful, trustworthy, and principled. He/she demonstrates character, conviction, and honest and ethical behavior in all interactions with others. The employee's word can be trusted. Behavior is consistent with these AVH Core Values EDUCATION/EXPERIENCE REQUIREMENTS High School degree preferred 2-3 years of experience in related field KNOWLEDGE AND SKILL REQUIREMENTS Ability to concentrate and show attention to detail Relatively high degree of analytical abilities Strong interpersonal skills required Ability to work independently LANGUAGE SKILLS Ability to read and communicate effectively in English Spanish preferred WORKING CONDITIONS Normal patient care environment with little exposure to excessive noise, dust and temperature May be exposed to communicable diseases through normal or careless performance of responsibilities May be exposed to mechanical dangers associated with mechanical devices May be exposed to stressful situations

Keywords: Aspen Valley Hospital, Aspen , Pre-Certification Specialist of Outpatient Clinics, Healthcare , Aspen, Colorado

Click here to apply!

Didn't find what you're looking for? Search again!


I'm looking for
in category
within


Other Healthcare Jobs


Physician / Surgery
Description: Join the National Center of Excellence for Wound Management Physician Group - Hiring
Company: Vohra Physicians
Location: Grand Junction
Posted on: 09/22/2018

Medical Assistant
Description: Medical Assistant Only one Vail. Only One Steadman Clinic.The goal of The Steadman Clinic is to deliver the highest standard of orthopaedic care and personal attention to each and every patient seeking (more...)
Company: The Steadman Clinic
Location: Vail
Posted on: 09/24/2018

Travel Nurse (RN) - Operating Room (OR) - 13 Weeks
Description: This is a 13 week travel RN Nurse - OR Operating Room assignment in GRAND JUNCTION,, CO. Don't miss this exciting Scrub/Circulate travel Registered Nurse job opportunity At Cirrus, you can count on (more...)
Company: Cirrus Medical Staffing
Location: Grand Junction
Posted on: 09/24/2018


OT Travel Job Occupational Therapist
Description: br Jackson Therapy Partners is currently seeking a licensed Occupational Therapist for a contract position at a state-of-the-art facility where expert therapy professionals help patients with injuries, (more...)
Company: Jackson Therapy
Location: Grand Junction
Posted on: 09/22/2018

Psychiatrist
Description: Major Duties: br br ul br li Inpatient and outpatient psychiatric care. li On call work. li Consultation to Medical and Surgical Services and Nursing Homes. li Team leader in multidisciplinary (more...)
Company: US Department of Veteran Affairs
Location: Grand Junction
Posted on: 09/24/2018

Physical Therapist (PRN)
Description: Responsible for evaluation, planning, directing and administering physical therapy modalities of treatment as prescribed by a licensed physician. Administers treatments and physical agents as prescribed (more...)
Company: Aspen Valley Hospital
Location: Aspen
Posted on: 09/22/2018

(Hospitalist -OB/GYN) Locum Tenens
Description: Obstetrics Gynecology opening in Grand Junction, Colorado. This and other physician jobs brought to you by DocCafe.com Job Description Requirements br Hospitalist -OB/GYN Locum Tenens br StartDate: (more...)
Company: Staff Care
Location: Grand Junction
Posted on: 09/22/2018

Full Time Registered Nurse
Description: Community Health Services, Inc. in Aspen is seeking a full-time Registered Nurse. Applicants must have a BSN and a Colorado nursing license. Bilingual in English and Spanish is strongly
Company: Community Health Services
Location: Aspen
Posted on: 09/22/2018

Occupational Therapist - 1 Year Experience Required (Aspen,CO)
Description: Of all the Healthcare Professional specialties we offer, Occupational Therapist are one of the specialties that have the most difference between staffing agencies in job / travel assignment locations (more...)
Company: HealthCare Traveler Jobs
Location: Aspen
Posted on: 09/24/2018

Healthcare Licensed Insurance Agent - Work From Home (Aspen,CO)
Description: Healthcare Licensed Insurance Agent - Work From Home Aspen,CO Join us at TTEC Home where we welcome Healthcare Licensed Insurance Agents who have a passion for helping others and
Company: TTEC
Location: Aspen
Posted on: 09/24/2018

Log In or Create An Account


Find us on Facebook

Find us on LinkedIn

Get the latest Colorado jobs by following @recnetCO on Twitter!

Aspen RSS job feeds