Pre-Certification Coordinator at Partner's Healthcare in Quincy, Massachusetts

Job Description:

Site: Massachusetts Eye and Ear Infirmary


At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission-from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.


At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare - people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds - to apply.



Job Summary
Responsibilities include contacting insurance plans and/or authorizing agencies to obtain prior approval for scheduled surgical/ancillary events.


This individual will be responsible for understanding all payer requirements and supporting the pre-certification/authorization process for all outpatient, surgical and ancillary procedures with the insurance carriers.


ESSENTIAL FUNCTIONS:
1. Work collaboratively and confidentially with support staff as well as other hospital departments, insurance carriers/authorizing agencies to obtain required pre-certification/approval for scheduled procedures.
2. Work collaboratively with health insurance carriers to verify/confirm eligibility. 3. Establish a contact network with the plans/agencies that will enable the pre-certification process to work quickly and efficiently.
4. Record all information related to approvals and denials including but not limited to the approval number, the date of the approval and name of the contact that are communicated to the provider in EPIC.
5. Communicate all pre-certification and/or authorization denials with MEE Financial Counselors and clinical areas.
6. Work closely with the physicians and their support staff to obtain the detailed information required to pre-certify a service. This includes obtaining complete registration, insurance, and the clinical data necessary for completing the pre-certification/authorization process.
7. Collaborate with support staff in situations where insurance carriers require additional clinical information such as peer to peer requests.
8. Work with Primary Care Physicians offices to obtain appropriate referrals and authorizations. Confirm this information with insurance carrier prior to the scheduled date.
9. Maintain strict confidentiality regarding all patient matters. Secure confidential information through the workday.



Qualifications


Required skills & experience:


Minimum of three years' experience in a health care setting.


Current knowledge of CPT/ICD-10-CM coding preferred.


Previous experience with pre-certification/approval processes and knowledge on managed care and other health insurance polices helpful.


Must possess the ability to communicate and deal effectively with patients, physicians, visitors, and peers in the course of performing job responsibilities.



Additional Job Details (if applicable)


Additional Job Description



Remote Type


Hybrid



Work Location


500 Congress Street



Scheduled Weekly Hours


40



Employee Type


Regular



Work Shift


Day (United States of America)



EEO Statement:


Massachusetts Eye and Ear Infirmary is an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.



Mass General Brigham Competency Framework


At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.