POSITION SUMMARY The Pre-Certification Specialist is responsible for obtaining precertification and benefit eligibility verification for patients at Trinity Health in a prompt and accurate manner to allow services to be rendered in a timely fashion. This position works collaboratively as part of the revenue cycle program to ensure clinical services are authorized based on insurance payer guidelines to minimize the reimbursement risks associated with providing care to patients. MINIMUM QUALIFICATIONS AND REQUIREMENTS Licenses and Certifications Required Educational Requirements High School diploma or equivalent preferred. Prefer Associates Degree in business or healthcare related field. Experience Requirements Minimum of one year medical insurance pre-certification and verification experience preferred. Working knowledge of CPT/ICD9 coding and medical terminology is desirable. Experience with third party payer billing regulations, reimbursement requirements, precertification, and/or utilization management is desirable. Special Skills or Training Requirements Demonstrated advanced communication and interpersonal skills with all levels of internal and external customers. Self-directed, attention to detail, PC experience, proficient in Microsoft Office Suite applications including Outlook, Word and Excel, excellent written and oral communication skills. Ability to handle high workload volume. Must be flexible and demonstrate ability to be adaptable.
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