Pre-certification Clerk

Description

GENERAL SUMMARY OF DUTIES: Precerts and documents all services ordered by the Physicians at The NeuroMedical Center. Verifies benefits of patients with insurance companies if necessary.

Requirements

TYPICAL POSITION DUTIES: (This list is not intended to be an exhaustive list of all duties required to be performed by the incumbent in this position. The contents are subject to change at management’s discretion.)

1. Pre-certs all services ordered by the Physicians at The NeuroMedical Center by completing all required information. Precerts are done online, via fax, or over the telephone.
2. Pre-certs are prioritized according to the upcoming date of service and insurance requirements.
3. The Precert clerk is responsible for following up on the precert requests in a timely manner to ensure the Precert process is completed. The precerts should be done for 3-5 days ahead at all times when possible.
4. If the services are not approved, the Clinical Supervisor and Medical Assistant/LPN are notified via EMR denial form. If the decision is made to cancel the appointment, the Clinical area employee is responsible for notifying the patient and cancelling the appointment in the system.
5. Communicate with clinical staff regarding additional information that may be needed to obtain authorization.
6. After the precert has been obtained, the authorization number is documented in the patient’s account in the practice management system.
7. Answers all phone calls related to outstanding precerts.
8. Performs various other duties as assigned by management.