Remote Precertification Coordinator

Precertification Coordinator

This position is fully remote but candidate must reside in: GA, IL, TN, AZ, NH, MA, CT, FL, or TX.

Why Neurocare?

Great introduction to Healthcare Administration 

Promotes from within (many of our coordinators have been promoted to other positions within the company)

Dynamic, professional environment

Excellent training

Independent work within a team environment

Learn about the exciting field of sleep medicine

Neurocare, Inc., is the largest employer of Sleep Technologists in the New England area for over 25 years.  We are a patient-centric, quality-focused organization.  We collaborate with high profile academic medical centers, community hospitals, and physician groups to design and manage state of the art sleep disorder programs.  Our strong commitment to uncompromising quality care and customer service has driven our reputation as a leader in the field. 

The Precertification Coordinator works as part of a team with responsibility for providing customer service to a wide range of internal and external customers within a busy clinical setting. Under general direction, coordinates all precertification aspects for sleep study referrals including facilitation of precertification information with the referring physician, educating the patient to the precertification process, working with the patient and physician to identify alternatives when a precertification is denied.

Essential Functions:

Identifies payor coverage and makes online and/or verbal inquiries to third party payers to verify pre-certification status.

Analyze physician medical record documentation and work with physicians to ensure optimal documentation of medical necessity and to qualify the patient for the optimal testing type given the patients’ needs, abilities, and functional status, comorbidities, and signs and symptoms of sleep disorders-within the payor guidelines.

Effectively utilize online and system resources to obtain missing information.

Submit precertification information received from the referring provider to the payor through online portal, phone, or fax, and monitor for decision outcome. Communicate outcome to physician and patient and accurately document in EMR.

Communicate with physicians to clarify orders or request an alternative study as approved by the payor, including appeal options or alternative testing.

Identify and communicate changes to precertification criteria, requirements, processes as required by payors.

Work closely with other team members, client administrative staff, physicians, and physician office staff to ensure highest level of customer service and compliance with regulatory guidelines.

Maintain current working knowledge of regulatory requirements, insurance guidelines and sleep testing criteria, communicating changes, trends, findings and outcomes as necessary to team members, managers, clients, and patients.

Requirements:

High school diploma

Bachelors degree preferred

2+ years relatable customer service/healthcare experience

Medical background and knowledge of medical terminology preferable

Skills and Competencies:

Excellent organizational skills with meticulous attention to detail

Strong analytic abilities, critical thinking and problem solving skills

Ability to multi task, handle a variety of situations 

Outstanding customer service and interpersonal skills

Good team and interpersonal skills 

Ability to work independently

Proficient with Microsoft Word and Excel; ability to adapt to new software

Strong written and verbal communication skills

Neurocare, Inc. EOE