Insurance Pre-Cert/Authorization Coordinator - Hospital Based

Pre-Certification/Authorization Coordinator

Psychiatric Hospital

Peachford Hospital is the Southeast's leading behavioral health and addictive disease treatment facility, providing compassionate care to children, adolescents, adults and seniors since 1973. Located in the beautiful Dunwoody neighborhood of north Atlanta, Peachford offers inpatient acute care, as well as partial hospitalization and intensive outpatient programs. Nearly 10,000 patients choose Peachford every year for their mental health treatment.

For more information on our hospital, follow us on online:

• https://www.linkedin.com/company/peachford-behavioral-health
• Peachford.com

We are searching for an Insurance Pre-Certification Coordinator to work full time Monday-Friday in our Utilization Review Department.

Pre-Certification Coordinators are responsible for obtaining prior authorizations for patient admissions to our continuum of care. This position is responsible for obtaining insurance benefits and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary care. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care. The Pre-Certification Coordinator provides detailed and timely communication to both payers and Peachford colleagues in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient record.

Responsibilities & Duties:

• Gather patient insurance benefit information needed in order to obtain pre-certification from insurance companies and document information in electronic medical record.
• Ensure timely and accurate insurance authorizations are in place prior to services being rendered when possible.
• nsures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third-party payer requirements/on-line eligibility systems.
• Contacts insurance carriers to obtain authorization/notification, and pre-certifications.
• Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
• Educates staff and providers regarding authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
• Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization.

The following requirements are needed to be successful in this position:

• Bachelor's degree in a business or social sciences field required. Equivalent healthcare/insurance experience may be considered in lieu of degree.
• Previous experience working in billing/prior authorization/insurance verification required.
• Possess a full knowledge of third-party payers and pre-authorization requirements.
• Knowledge of online insurance eligibility systems.
• Ability to communicate with staff and providers, in person, in writing and over the telephone, in a tactful manner and under difficult situations.
• Demonstrate the ability to efficiently organize work and maintain a high level of accuracy and productivity without constant supervision

What Happens Next?

After you apply online and submit your resume, a member of our recruiting team will review your qualifications and experience. If we are interested in scheduling an interview, someone will give you a call. You may log back on to this website to check the status of your application at any time.

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All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

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