The Precertification Specialist is responsible for obtaining prior authorizations/pre-certifications, as required by third party payers, for procedures, testing and surgeries performed in the department or elsewhere.The position regularly interacts and collaborateswith clinicians, technicians, other department staff and payer representatives to gather and submit necessary information, and then communicates with patients regarding their benefits and expected out-of-pocket costs.
Obtains precertification/prior authorizations for in clinic procedures, testing, surgeries, injections, etc., as required by insurance prior to scheduled date for both facility and physician
Coordinates with physician to ensure that patient’s condition meets insurance eligibility criteria
Updates appropriate work queues within Epic, including notes with updates on calls made, departments/people spoke with, prior auth numbers and authorization periods
Interacts with the Financial Clearance Center Team to coordinate information needed to communicate benefits and patient responsibility for the facility billing portion
Runs report on Experian to obtain the physician billing estimate and interacts with the Physician CBO to coordinate information needed to communicate benefits and patient responsibility for the physician billing portion
Communicates regularly with patient to update on prior authorization and to provide patient responsibility estimate for both facility and physician billing sides.
• Interacts with OR and/or ASC staff to obtain scheduling information and to coordinate communication to the patient
Schedules procedure with vendor rep, as needed
Applicable Experience:
1 yearFull TimeDay (United States of America)
The best place to get care. The best place to give care Saint Luke’s 12,000 employees strive toward that vision every day. Our employees are proud to work for the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke’s means joining a team of exceptional professionals who strive for excellence in patient care. Do the best work of your career within a highly diverse and inclusive workspace where all voices matter.
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About Saint Luke’s
Saint Luke’s serves the West Region of BJC Health System as a faith-based, nonprofit, aligned health system committed to providing the highest levels of excellence in compassionate health care and health-related services. Saint Luke’s cares for patients in 65 specialty services across 67 counties in Missouri and Kansas. Saint Luke’s Hospital has been recognized by U.S. News & World Report as one of the elite hospitals in the nation. For more than 140 years, Saint Luke’s has been dedicated to enhancing the physical, mental, and spiritual health of the diverse communities we serve.
Saint Luke’s offers:
- The region’s longest continuously operating adult heart transplant program and one of the nation’s leading cardiovascular programs at Saint Luke's Mid America Heart Institute
- Treatment for complex brain and spinal cord diseases and one of the nation’s leading stroke reversal programs at the nationally ranked Saint Luke’s Marion Bloch Neuroscience Institute
- The region’s only treatment center dedicated exclusively to treating metastatic breast cancer—the Koontz Center for Advanced Breast Cancer at Saint Luke’s Cancer Institute
- Saint Luke’s Convenient and Urgent Care clinics for treatment of minor illnesses and injuries
- Liver and kidney transplantation programs
- A comprehensive maternal-fetal diagnostic and treatment center
- Three Neonatal Intensive Care Units, including a Level IIIb NICU at Saint Luke’s Hospital of Kansas City
- Saint Luke’s Rehabilitation Institute, the only comprehensive inpatient rehabilitation hospital of its kind in the region
- A nationally recognized children's behavioral health center, Saint Luke’s Hospital Crittenton Children’s Center
