Position Summary:

Responsible for obtaining pre-certifications and pre-authorizations for hospital service lines per assigned caseload by successfully completing the required authorization process in addition to effectively communicating details to appropriate departments.

 

 

Position Responsibilities:

Clinical / Technical Skills (40% of performance review)

 

• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations.


• Request, track and obtain pre-authorization from insurance carriers within time allotted for assigned workload and follow up on regularly pending cases.


• Ensure tracking programs and patient records are kept up to date through the pre-certification process.


• Demonstrate and apply knowledge of medical terminology, high proficiency of general inpatient hospital understanding including HIPAA regulations.


• Clearly document all communication and contacts with providers and personnel in standardized documentation requirements.


• Communicate any insurance changes or trends among team.


• Prioritize authorization requests according to urgency.


• Answer insurance telephone inquiries pertaining to patient accounts.


• Perform other duties as required.

 

 

Safety (15% of performance review)

• Strives to create a safe, healing environment for patients and family members


• Follows all safety rules while on the job.


• Reports “near misses”, as well as errors and accidents promptly.


• Corrects minor safety hazards.


• Communicates with peers and management regarding any hazards identified in the workplace.


• Attends all required safety programs and understands responsibilities related to general, department, and job specific safety.


• Participates in quality projects, as assigned, and supports quality initiatives.


• Supports and maintains a culture of safety and quality.

 

Teamwork (15% of performance review)

• Works well with others in a spirit of teamwork and cooperation.


• Responds willingly to colleagues and serves as an active part of the hospital team.


• Builds collaborative relationships with patients, families, staff, and physicians.


• The ability to retrieve, communicate, and present data and information both verbally and in writing as required


• Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word.


• Demonstrates adequate skills in all forms of communication.


• Adheres to the Standards of Behavior

 

Integrity (15% of performance review)

• Strives to always do the right thing for the patient, coworkers, and the hospital


• Adheres to established standards, policies, procedures, protocols, and laws.


• Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence.


• Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources.


• Completes required trainings within defined time periods, as established by job description, policies, or hospital leadership


• Exemplifies professionalism through good attendance and positive attitude, at all times.


• Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws.


• Ensures proper documentation in all position activities, following federal and state guidelines.

 

Compassion (15% of performance review)

• Demonstrates accountability for ensuring the highest quality patient care for patients.


• Willingness to be accepting of those in need, and to extend a helping hand


• Desire to go above and beyond for others


• Understanding and accepting of cultural diversity and differences