Pre-Certification Coordinator II (Remote) - Neurology

Job description

Scheduled Hours 40 Position Summary: Advanced level specialization in complex pre-certifications as indicated on therapy and treatment plans to prevent controllable losses/write offs for the Department. May perform re-checks of insurance eligibility and verify authorization information for each service. Documents all pertinent authorization information in EPIC and communicates with clinical staff and providers in a timely and effective manner. Job Description: Primary Duties & Responsibilities: Completes pre-certifications for complex and high dollar drugs as indicated on therapy and treatment plans. Must read and analyze therapy and treatment plans, drug protocols and clinical documentation, as well as payer policies and patient benefits. Completes the authorization process with the payer and in EPIC. Completes re-checks on existing pre-certifications by verifying insurance eligibility and all authorization information for all applicable services. Confirms all re-check information is documented in EPIC. Works with clinical staff and providers on add-ons, denials and peer to peers through to resolution in a timely fashion. Other duties as assigned, such as assistance with denials,...