pre Admission Specialist
Company: Covenant Healthcare
Posted on: January 9, 2022
PART TIME BENEFITED, 40 HOURS PER PAY
The Pre-Admissions Specialist demonstrates excellent customer
service performance in that his/her attitude and actions are at all
times consistent with the standards contained in the Vision,
Mission and Values of Covenant and the commitment to Extraordinary
Care for Every Generation. The pre-certification Specialist
coordinated pre-certification activities for scheduled patients by
screening all elective admissions and procedures for
appropriateness, looking at medical necessity and intensity of
service. He/she performs authorization procedures for radiology
testing and specific outpatient procedures. He/she maintains
current database regarding payor requirements and authorization
Demonstrates excellent customer service.
Contributes to organization success targets for patient
Contributes to organization success targets for net operating
Ensures the availability of accurate and timely information.
Demonstrates age specific competency in the selected age groups:
newborn, infant, pediatric, child, adolescent, adult, and
Reviews documentation and works with physician/offices to assure
that appropriate Patient Class is assigned prior to procedures.
Knowledgeable regarding Medicare ABN requirements, assists with
issuing when appropriate.
Knowledge of Federal, State and Local government regulations as
they relate to Precert and billing requirements.
Works collaboratively with Admitting, Scheduling, CBO, HIM, and
Finance Department to optimize reimbursement.
Completes payor pre-notification / pre-certification to obtain
approval authorization for scheduled surgical patients.
Acts as a final gatekeeper for CRM case management specialist on
criteria application prior to elective patients receiving services
at Covenant HealthCare.
Coordinates contact between physician and payors.
Manages and responds to concurrent third party payer denials of
outpatient and inpatient cases alleged to be medically
Maintains an organized database of payor requirements and
Prepares, issues, distributes, and tracks notices of
Mentors Insurance Advisors and others on reimbursement requirements
and strategies for success.
Keeps up to date of third party payor contracts and their
Works with the healthcare team to demonstrate fiscal responsibility
by being conscious of the need to appropriately use the resource
Maintains flexibility to changes in delivery of clinical
information, i.e. electronic transfer.
Serves as a resource to the health care team related to denial
management and utilization management.
Demonstrates excellent communication skills, negotiation skills,
diplomacy and assertiveness.
Builds and nurtures professional, effective relationships with all
members of the Healthcare team.
Manages conflict effectively, striving for win-win outcomes.
Serves as a liaison that interacts with physician office staffs and
facilitates meetings with payers. Works to maximize positive
RN with current license in State of Michigan required.
3 years clinical experience required
Successful performance in utilization management preferred.
Clinical experience with understanding of disease process and
treatment regimens associated with designated patient
Strong computer skills.
Excellent verbal and writing skills along with diplomacy,
negotiation and assertiveness skills.
Critical thinking skills, analyzing multiple issues impacting
Problem solving skills and the ability to manage many situation
simultaneously. Able to adjust to priorities that may change minute
Strong commitment to collaboration and teamwork, with demonstrated
ability to work as a member of a team where assignments must be
coordinated with peers.
Has a solid understanding of the Healthcare industry, technology
A professional approach to work, including a strong sense of
responsibility for assigned duties.
WORKING CONDITIONS/PHYSICAL DEMANDS
Ability to maintain punctual attendance consistent with the ADA,
FMLA, and other federal, state, and local standards.
Frequent standing, walking, sitting, talking, hearing and near
Occasional lifting up to 100 lbs.
Occasional lifting, carrying, pushing, pulling, climbing,
balancing, stooping, kneeling, crouching, squatting, crawling,
twisting, reaching, handling, feeling, midrange vision, far vision,
depth perception, visual accommodation, color vision and field of
NOTICE REGARDING LATEX SENSITIVITY IN APPLICANTS FOR
It has been determined that Covenant HealthCare cannot provide a
latex safe or latex free work environment at any of its facilities.
Unfortunately, that means that any individual, including an
applicant or an employee, is likely to be exposed to latex while on
Covenant's premises. Therefore, latex tolerance is considered to be
an essential function for any position with Covenant.
Keywords: Covenant Healthcare, Saginaw , pre Admission Specialist, Other , Saginaw, Michigan
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