Pre-certification Coordinator 1

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Job Title:

Department:

Scope of Position

The Ohio State University Health System is committed to improving access and service to customer.  The Pre-Certification position functions as an integral member of the health care team to reflect a culture of cooperation, enthusiasm and mutual respect.  This position ensures the coordination of the insurance verification and precertification process for all outpatient procedures, inpatient admissions and outpatient surgeries and other designated services for patients to The Ohio State University Health System.

Position Summary

The Pre-Certification coordinator’s responsibilities include understanding and verifying benefits for Outpatient, Inpatient and Ambulatory Surgery Services as well as obtaining prior authorization for visits, procedures and hospitalizations, pre-approval, PCP referrals, and predeterminations for all electively scheduled admissions and outpatient surgeries and other designated outpatient visits. In addition, the analyst will at times contact patients/families to determine additional demographic and insurance information essential to the authorization processes while also informing patients of co-pays that will be due. 

Minimum Qualifications

High School diploma or GED, and 6 months Relevant Experience in Health Care Setting/Existing, Revenue Cycle Department OR Customer Service Experience OR Experience with authorization work in an insurance company, physician practice, or hospital setting. Experience with medical terminology and payer requirements preferred. Experience with Windows, Excel, and intranet/internet navigation tools as well as system content. Demonstrated ability to work in multiple databases and software applications; experience using automated databases for management and reporting.  Ability to work in self-directed manner while interacting with consumers, physicians and all medical center faculty and staff.  Ability to communicate clearly with health care team.

FUNCTION: Finance
SUB-FUNCTION: Revenue Cycle Pre-certification
CAREER BAND Individual Contributor - Technical
CAREER LEVEL: 1

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