Full employer posting
Recommends the most efficient, cost effective utilization of resources within the continuum of care, prior to the delivery of services. Evaluates, assesses, plans, and facilitates a plan of care. Obtains/Validates insurance prior authorizations and pre-certification for inpatient and/or outpatient healthcare services.
Some overtime and call back is required. This position is under the general direction of the leadership of Centralized Patient Access or Baptist Connected Center-Corporate. Performs other duties as assigned.
Responsibilities Assesses and evaluates clinical and financial information available and recommends the most appropriate setting for service delivery, including level of care in order to optimize resource consumption and reimbursement. Precertifies patient care services that require precertification, as identified, in a timely, efficient manner, in order to optimize reimbursement for the patient, as well as health care providers.
Communicates recommendations, clinical information, and fiscal information to appropriate internal and external customers in order to facilitate optimal delivery of services and customer satisfaction. Participates in the planning, data collection, and analysis phases of performance improvement activities in order to maximize the patient placement/precertification process. Completes assigned goals.
Specifications Experience Minimum Required 5 years of business/clinical experience in a healthcare setting with a focus in patient access, business office, and/or case management areas. Preferred/Desired 8 years of business/clinical experience in a healthcare setting with a focus in patient access, business office, and/or case management areas. Education Minimum Required Associates degree or equivalent years of work experience.
Preferred/Desired Bachelors degree or equivalent years of work experience. Training Minimum Required Preferred/Desired Special Skills Excellent communication skills. Advanced computer literacy skills.
Minimum Required Excellent communication skills. Advanced computer literacy skills. Preferred/Desired Licensure Minimum Required Preferred/Desired LPN or CMA
About the role
Recommends the most efficient, cost effective utilization of resources within the continuum of care, prior to the delivery of services. Evaluates, assesses, plans, and facilitates a plan of care. Obtains/Validates insurance prior authorizations and pre-certification for inpatient and/or outpatient healthcare services.