Job Number 59357
Posted 12/19/2018
Account Northern Light Mercy Hospital
Location |ME| WESTGATE - Portland, ME 04102
Schedule Regular Full-time
Shift Day
Hours Days
Job Details
Job Summary:

Under the guidance and general supervision of the Westgate Front Office Supervisor, the precertification specialist is the primary resource for completion of pre-certification/authorizations, insurance verifications, verification of accurate diagnosis codes, and tracking of required certification forms. The incumbent acts as a liaison between the front office and the hospital's billing office with input from the Supervisor and Manager, as needed. The precertification specialist is also responsible to inform all new patients of coverage issues, assist patients with billing forms completion and answer questions on an ongoing basis. This position is available to assist with training and ongoing monitoring of all aspects of billing, registration and scheduling functions. The incumbent performs duties and tasks in accordance with performance standards established for the job. In addition, the incumbent conducts all job responsibilities according to the Mission and Values of Mercy Hospital.


Post-secondary education and training or relevant experience in a healthcare field and/or medical office environment is required, to include an understanding of registration and scheduling functions. Experience with medical billing, charge entry, and third party payer processes is strongly desired. Must be able to operate independently to complete all tasks with minimal supervision. Must have excellent interpersonal skills to interact with individuals in all levels of the organization, patients, the public, and outside agencies, as the incumbent's interactions have a direct effect on patient satisfaction. Must have good organizational skills and be able to manage multiple tasks at the same time. Must be accountable for accuracy and timeliness of work as the incumbent's performance directly affects quality and financial performance Incumbent has access to highly confidential patient information.

Principal Responsibilities:

Job Specific Performance

Completes insurance verification for all scheduled therapy and physical medicine appointments to determine eligibility and pre-certification/authorization requirements

· Reviews all scheduled new patients to verify insurance information

· Contacts insurance company as needed for pre-certification or authorization requirements

· Enters authorization information into appropriate computer systems

· Alerts therapist/provider to authorization information

· Obtains additional authorizations as needed.

Verifies appropriateness of diagnosis code for scheduled appointment

· Reviews all scheduled new patient diagnosis information to verify medical necessity for requested services.

· Researches any medical necessity issues and identifies appropriate course of action – ie, contact referring physician, assist patient with completion of ABN/waiver form as applicable, notify therapist/provider, etc.

Provides patient education re: the billing process

· Reviews coverage issues with all new patients

· Assists patients with completion of any required billing forms

· Answers any billing related questions that patients may have

Tracks required certification forms on spreadsheet – Medicare/Mainecare, etc.

· Point person for collection, transmission and receipt of all required certification forms

· Maintains tracking sheet to ensue that certification forms are completed and up to date

· Works closely with therapy staff and providers to update them on status of forms

Resolves questions, issues and problems related to billing questions

· Follows up with appropriate payers to resolve problems and answer questions

· Works cooperatively with hospital staff, departments and patients to identify and resolve billing discrepancies

Cross trained to provide receptionist relief coverage when needed

Completes all aspects of patient reception, registration and scheduling functions when needed

Assists the office supervisor with training and quality monitoring of scheduling and registration functions

· Assists with new staff orientation and on-going training as needed to support the registration and scheduling functions of the department

· Assists with ongoing monitoring of registration/scheduling information accuracy; reports findings to front office supervisor

Accepts responsibility for furthering professional practice and leadership.

· Actively seeks opportunities to further own professional growth.

· Participates in continuing education programs; attends pertinent in-services and mandatory programs.

Performs additional duties as required or assigned.

Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.