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Penn Medicine, University of Pennsylvania Health System · 1 day ago

Precertification Specialist

Ewing, NJ

Full-time

Onsite

Entry, Mid Level

$18.97/hr - $29.20/hr

2+ years exp

Penn Medicine is dedicated to providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. The Precertification Specialist is responsible for obtaining referrals and authorizations for outpatient visits, testing, or procedures, while also serving as the in-house expert for referral and authorization requirements.

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Responsibilities

Maintains up to date knowledge of insurance requirements pertinent to patient services and billing procedures

Updates information in EMR including but not limited to: demographics, insurance, referral, pre-authorizations according to UPHS protocol

Responsible for facilitating maximum revenue for the practice by managing strategies to collect monies from third party payers by ensuring referrals or authorizations have been obtained. Works to obtain any missing data or information so that the billing processes may proceed seamlessly

Comprehends insurance and registration information as it relates to the various plans and benefits. Understands the need for referrals and pre-certs according to insurance requirements and coding

Communicates front end issues which may impact revenue process to manager

Receives and responds to all correspondence, telephone calls, and other inquiries from designated carriers and patients

Qualification

Insurance knowledgeReferral managementAuthorization processesEMR proficiencyCommunication skills

Required

H.S. Diploma/GED (Required)

2+ years relevant experience

Preferred

Bachelor of Arts or Science (Preferred)

experience with pre-certs, referrals and prior auths preferred

Benefits

Comprehensive compensation and benefits program

Prepaid tuition assistance programs

Company

Penn Medicine, University of Pennsylvania Health System

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Penn Medicine is a world leader in academic medicine, setting the standard for cutting-edge research, compassionate patient care, and the education of future health care professionals.

Founded in 1765

Philadelphia, Pennsylvania, USA

10001+ employees