Job Summary

Recommends the most efficient, cost effective utilization of resources within the continuum of care, prior to the delivery of services. Evaluates, assesses, plans, and facilitates a plan of care. Obtains/Validates insurance prior authorizations and pre-certification for inpatient and/or outpatient healthcare services. Some overtime and call back is required. This position is under the general direction of the leadership of Centralized Patient Access or Baptist Connected Center-Corporate. Performs other duties as assigned.

Required Population Served

Job Responsibilities

• Assesses and evaluates clinical and financial information available and recommends the most appropriate setting for service delivery, including level of care in order to optimize resource consumption and reimbursement.
• Precertifies patient care services that require precertification, as identified, in a timely, efficient manner, in order to optimize reimbursement for the patient, as well as health care providers.
• Communicates recommendations, clinical information, and fiscal information to appropriate internal and external customers in order to facilitate optimal delivery of services and customer satisfaction.
• Participates in the planning, data collection, and analysis phases of performance improvement activities in order to maximize the patient placement/precertification process.
• Completes assigned goals.

Specifications

Experience Description

Minimum Required: 5 years of business/clinical experience in a healthcare setting with a focus in patient access, business office, and/or case management areas.

Preferred/Desired: 8 years of business/clinical experience in a healthcare setting with a focus in patient access, business office, and/or case management areas.

Education Description

Minimum Required: Associates degree or equivalent years of work experience.

Preferred/Desired: Bachelors degree or equivalent years of work experience.

Training Description

Minimum Required: Special Skills Description

Minimum Required: Excellent communication skills. Advanced computer literacy skills.

Licensure Description

Minimum Required: LPN or CMA