This position is responsible for training, daily oversight, and work direction of the Precertification Team and requires demonstrated success as a Precertification Specialist. Maintains the master schedule, covers open shifts, updates PTO calendar. Responsible for the following daily activities: monitoring workflow, assigning work, auditing staff, running reports, and problem solving for staff issues. Supports Manager by attending meetings, providing input for staff performance appraisals and assisting with other duties as assigned. Assists Manager in identifying and implementing process improvement initiatives. Provides staff education to improve performance and is able to work in multiple Service lines. Provides back-up for multiple Precertification Service Lines. Ensures adherence to departmental guidelines and assists with performance measures. This position demonstrates a high degree of job knowledge and skill in the processes related to Insurance Verification and Precertification of Infusion, Radiology and Surgery Service Lines and Inpatient Notification of Admission.
Job Requirements:
High School Degree in General Studies
Proven apptitude for creating and providing training
Understands basic concepts of process improvement
Able to perform multiple complex processes
2-3 years experience Healthcare
Job Responsibilities:
Obtains precertification in compliance with established guidelines and processes. Has ongoing knowledge of organizational and payer protocols to determine the amount of time needed to obtain precertification for various service lines. Creates and follows scripting and documentation for precertification in order to maximize reimbursement for the organization. Works a daily dashboard to ensure that all accounts are secured and approved.
Responsible for overseeing and delivering training to new and existing Team Members. Supports continuous improvement by identifying errors, problems and issues while making suggestions for correction of problems. Communicates quality issues to staff in a positive manner, OR; coordinates changes and identifies opportunities for improvement. Updates and maintains resource manual with material that is crucial to the success of the Team..
Reviews denials to identify trends warrenting process improvement and provides coaching for Team Members. Provides meaningful statistical information and provides a tool for feedback.
Corrects quality errors in an appropriate time frame to ensure accurate information flows to billing, OR: Works with management team to identify changes needed in processes. Meets deadlines for projects.
Audits precertifications for quality measures, i.e. ensure consistent format for data entry, accuracy of insurance information and appropriate documentation for approval or possible appeal of billed accounts.
Conducts Team Huddles Weekly and communicates important process changes and updates.
Other Job-Related Information:
Working Conditions:
Climbing - Rarely
Concentrating - Consistently
Continuous Learning - Consistently
Hearing: Conversation - Consistently
Interpersonal Communication - Consistently
Kneeling - Rarely
Lifting <10 Lbs - Rarely
Pulling - Rarely
Pushing - Rarely
Reaching - Rarely
Sitting - Frequently
Standing - Rarely
Stooping - Rarely
Thinking/Reasoning - Consistently
Use of Hands - Frequently
Color Vision - Consistently
Walking - Occasionally
TriHealth SERVE Standards and ALWAYS Behaviors
At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:
Serve: ALWAYS…
• Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
• Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
• Refrain from using cell phones for personal reasons in public spaces or patient care areas
Excel: ALWAYS…
• Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
• Offer patients and guests priority when waiting (lines, elevators)
• Work on improving quality, safety, and service
Respect: ALWAYS…
• Respect cultural and spiritual differences and honor individual preferences.
• Respect everyone’s opinion and contribution, regardless of title/role.
• Speak positively about my team members and other departments in front of patients and guests.
Value: ALWAYS…
• Value the time of others by striving to be on time, prepared and actively participating.
• Pick up trash, ensuring the physical environment is clean and safe.
• Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
Engage: ALWAYS…
• Acknowledge wins and frequently thank team members and others for contributions.
• Show courtesy and compassion with customers, team members and the community
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