Pre-Cert Specialist - Illinois CancerCare

Illinois CancerCare is seeking a full-time Precertification Specialist within the business office. Precertification Specialists are Responsible for obtaining precertification’s/authorizations for testing services provided inside and outside of Illinois Cancer Care to patients.  Will work collaboratively with physicians and staff to ensure all precertification requirements are met prior to the date of service. 

1. Answer calls regarding insurance precertification inquires.
2. Will work very closely with ILCC Receptionists and Billing Office personnel, outside physician offices, hospitals, and patients. Exemplary customer service skills are expected.
3. Verify patient eligibility and pre-certification requirements through on-line verification, telephone or Fax.
4. Documents all pre-certification information into the patients EMR.
5. Maintains reference materials as they pertain to insurance carrier procedures.
6. Review physician orders and clinical data matching it against specific medical terms and diagnosis or procedure codes (without the need for interpretation).
7. Follow established insurance procedures for authorizing CT, PET, MRI, Molecular, Genetic testing, PCP Authorizations etc. or referring request on to the Physician for further review.
8. When requested, and in a timely manner, provide insurance companies with supportive medical documentation.
9. Verify receipt of all necessary pre-authorization documents prior to the patient’s scheduled test.
10. Attends required training to maintain knowledge of payer regulations & to receive updated coding information as it pertains to pre-authorization processes.
11. Communicate effectively with facilities in which the procedure will be performed as needed.
12. Maintain proper public relations attitude in order to assure the oncology patients that their interest is of primary concern.
13. Observe OSHA and facility policies and procedures.
14. Work additional hours when requested by your manager.
15. Report to work station on time and remain available throughout the workday.
16. Communicate to Illinois CancerCare staff and outside facilities in a courteous, professional, and helpful manner.
17. Follow policies and procedures set forth by Illinois CancerCare as well as departmental policies & procedures.
18. Follow all HIPAA regulations as outlined in the Policies and Procedures Manual.

 SPECIAL PHYSICAL REQUIREMENTS

1. Requires prolonged standing or sitting.
2. Requires frequent bending, reaching, squatting, stooping.
3. May require lifting up to 50 pounds.
4. Hand-eye coordination and manual dexterity is a must.
5. Hearing must be within normal range for telephone contact.
6. Must be able to operate office equipment such as, computers, telephones, faxes or copy machines.
7. Requires normal vision range and the absence of color blindness.

 SAFETY CONSIDERATIONS/TYPICAL WORKING CONDITIONS

1. The employee has limited exposure to toxic substance and is expected to be familiar with the dangers and proper handling of such.
2. The employee is exposed to communicable diseases and other conditions common to the clinical environment.
3. Safety policies and good health practices are to be understood and observed.
4. Work is performed in an office environment.
5. It involves frequent contact with staff and patients.
6. Work may be repetitious as well as stressful at times.
7. Contact may involve dealing with angry or upset people.

High School graduate or equivalent required

Medical Terminology use and understanding is required

Certified Professional Coder Preferred

3-5 years’ experience in a similar position in a medical office preferred.