Job Summary 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 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 Preferred/Desired 5 years of business/clinical experience in a healthcare 8 years of business/clinical experience in a healthcare setting with a focus in patient access, business office, and/or case management areas. setting with a focus in patient access, business office, and/or case management areas. Education Description Minimum Required Preferred/Desired Associates degree or equivalent years of work experience. Bachelors degree or equivalent years of work experience. Training Description Minimum Required Preferred/Desired Special Skills Description Minimum Required Preferred/Desired Excellent communication skills. Advanced computer literacy skills. Excellent communication skills. Advanced computer literacy skills. Licensure Description Minimum Required Preferred/Desired LPN or CMA
Baptist Memorial Health Care is one of the country’s largest not-for-profit health care systems and the largest provider of Medicaid in the region. Baptist offers a full continuum of care to communities throughout the Mid-South and consistently ranks among the top integrated health care networks in the country. The health care system comprises 24 affiliate hospitals in West Tennessee, Mississippi and East Arkansas; more than 5,400 affiliated physicians; Baptist Medical Group, a multispecialty physician group with more than 900 providers; home, hospice and psychiatric care; minor medical centers and clinics; a network of surgery, rehabilitation and other outpatient centers; and an education system highlighted by Baptist Health Sciences University (formerly Baptist College of Health Sciences). Baptist employs more than 21,000 people, and in fiscal year 2022 contributed more than $455 million in community benefit and uncompensated care to the communities it serves. For more information, please visit www.baptistonline.org or follow us on Facebook or Instagram.
