Penn Medicine, University of Pennsylvania Health System · 1 day ago
Insurance Pre-Cert Coordinator for Infusion Services - Full time
Philadelphia, PA
Full-time
Onsite
Mid Level
3+ years expPenn Medicine is a leading academic medical center dedicated to providing high-quality patient care and conducting innovative research. The Insurance Pre-Cert Coordinator for Infusion Services is responsible for obtaining pre-certifications and referrals, ensuring optimal reimbursement for the hospital services provided, and maintaining communication with patients and insurance companies.
BiotechnologyEducationHealth CareMedicalTraining
Responsibilities
Review chemo schedule in advance and determines patients insurance requirements for pre-cert, patient payments, coverage limitation and determine necessary action prior to patient arrival
Assess information for appropriateness of setting and utilization of resources to optimize patient outcomes and cost effectiveness
Maintain communication with provide education to all involved departments included but not limited to admissions, business office, case managers and medical staff and designees
Provide required clinical and demographic information to payer to obtain precertification and assure reimbursement
Communicate with patients to verify incomplete insurance information and remind the HMO patients to obtain a referral and make patient aware of any co-pays
Pre-certify and obtain authorization numbers and enter into Epic insurance flowsheet
Obtaining medical, ICD-9 and CPT codes
Interact with medical staff and their designees to obtain complete, accurate, timely clinical and financial information required for payer reimbursement
Fax all information required to insurance companies to ascertain an authorization number for pre-cert
Keeping within the standards set by the Office of Compliance and HIPPA in reference to confidentiality
Assist admissions representative obtaining pre-cert and authorization numbers
Keep representatives apprised of any changes in the process
New and improved methods of obtaining insurance authorizations Internet, envoy
Follow up with all review companies on all pending authorizations and referrals
Checks-in/arrives patient appointments daily in Epic
Pre-register appointments 24 hours in advance of patient's appointment
Maintain excellent working relationships with all insurance companies
Communication and maintain excellent working relationships with referring physicians and their staff
Work approximately one week in advance whenever possible
Provide accurate information to billing and case management to assure payment of claims
Willingly accepts responsibility and demonstrates positive and competent performance
Provides ongoing education and exhibits a willingness to share current knowledge with team members as necessary to help meet organizational goals
Maintain current knowledge about pre-certification process for all Federal, State, and 3rd party payors
Identifies systems issues impacting on the use of resources
Observance of or Patient Access Hospitality House Rules
Courtesy and politeness
Friendliness
Concern for each patient's well being
Sensitivity and prompt responsiveness to the patient's wants and needs
Cooperation with and helpfulness to the patient, members of the patient's family, visitors and co-workers
Pride in self, professions and the hospital
Respect for other people
Key Team partners include: Patient Accounting Team including Financial Counseling, Registration, Nursing Management, SPU staff, Physician Office staff, CBO management
Shares resources and information across boundaries to ensure customer needs are met and status of the revenue cycle is maximized
Supports proactive communication to enable high performance of all individuals
Ability to assess, prioritize and complete multiple tasks in a stressful environment
Judgement capability to differentiate between decisions which can be made independently and those that should be referred to management
Problem solving - take initiative to correct problematic situations
Communicates appropriately and effectively with supervisors, nurse managers, peers, patients/customers and outside agencies
Follow professional and proper telephone etiquette using interpersonal skills and required job knowledge (List)
Effective management skills including but not limited to communication, conflict resolution, problem solving, work redesign and policy and procedure documentation
Working knowledge of hospital billing and reimbursement issues as they relate to information required at time of outpatient care
Epic Schedgistration Training (can be completed after hire)
Proactively shares information and trends
Treats colleagues and staff with dignity and respect
Ensures absolute confidentiality
Creates a work environment that attracts and remains key talent
Facilitates the identification of common goals
Identifies opportunity for improvement
Prioritizes own work with minimal involvement of supervision
Takes personal responsibility for Department performance
Qualification
Required
H.S. Diploma/GED (Required)
3+ years Minimum of 3 years experience in a healthcare environment or education in lieu of experience (Associate's or Bachelor's degree)
Ability to assess, prioritize and complete multiple tasks in a stressful environment
Judgement capability to differentiate between decisions which can be made independently and those that should be referred to management
Problem solving - take initiative to correct problematic situations
Communicates appropriately and effectively with supervisors, nurse managers, peers, patients/customers and outside agencies
Follow professional and proper telephone etiquette using interpersonal skills and required job knowledge
Effective management skills including but not limited to communication, conflict resolution, problem solving, work redesign and policy and procedure documentation
Working knowledge of hospital billing and reimbursement issues as they relate to information required at time of outpatient care
Epic Schedgistration Training (can be completed after hire)
Ensures absolute confidentiality
Creates a work environment that attracts and remains key talent
Facilitates the identification of common goals
Identifies opportunity for improvement
Prioritizes own work with minimal involvement of supervision
Takes personal responsibility for Department performance
Benefits
Comprehensive compensation and benefits program
Prepaid tuition assistance programs
Company
Penn Medicine, University of Pennsylvania Health System
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.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$70.9MKey Investors
BIRD FoundationWarren Alpert FoundationNational Cancer Institute
2025-01-22Grant
2023-01-03Grant· $9.7M
2022-08-18Grant· $5.7M
Leadership Team
Kevin Mahoney
Chief Executive Officer of University of Pennsylvania Health System
John Donohue
Vice President, Enterprise Services
Recent News
The Philadelphia Inquirer
2026-01-03
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