Pre-Certification Specialist

Job Number 64589
Posted 9/12/2019
Account Northern Light Mercy Hospital
Department Northern Light Mercy Cancer Care
Schedule Regular Full-time
Shift Day
Hours 8
Job Details Job Summary:

Under the direction of the Manager of Oncology, the Pre-Certification Specialist Serves as a patient advocate, liaison, and educator to assist patients with understanding the cost of care and navigating the continuum of care. Provides services in areas of financial need to patients, families, and the health care team as appropriate. Provides patient and health care team education, links to resources and data collection in support of easing the financial hardship on patients and their families seeking oncological services. Serves as an expert in insurance verification and eligibility and medical necessity and the attainment of prior drug authorizations when required by insurance carrier for all medications ordered and administered in the Oncology Program. This applies to all scheduled and emergent patients for any given day. This person serves as a liaison between physicians, clinical team, patients, pharmacies, and contracted insurance plans. This position is responsible for the research of patient eligibility and access to patient assistance programs and community resources to mitigate potential fiscal risk to patient and organization.. Works with health insurance providers to determine coverage, benefit limits, and financial responsibility and conveys this information to the clinical team, patient, and family. The Specialist will be instrumental in obtaining written documentation, tracking, and reporting outcomes of each authorization request. The Specialist will be in a position to interface directly with medical staff, pharmacy, financial counselors and billers to ensure a seamless process to the patients receiving outpatient treatments.

The incumbent may have access to highly confidential patient, employee and/or Mercy proprietary information, and must handle & protect the information in accordance with hospital & system policies, HIPAA requirements and the highest level of ethical standards. The incumbent is responsible for reporting all security events, potential events, or other security risks to the organization. The incumbent is responsible for participation in and completion of all patient safety initiatives appropriate to the position, and conducts all job responsibilities according to the Mission and Values of Mercy Hospital.


High school diploma. Strong communication skills, attention to detail, and a high level of organization are critical qualities. Possesses a high level of customer service experience and commitment to providing customer service excellence. Medical Terminology is required A minimum of one (1) year experience in a health related, or health insurance field, or similar role, required, oncology experience a plus. Awareness of philosophy of care as it relates to patient financial services. Knowledge of commercial and State/Federal insurance preferred. Must be able to operate independently to complete all tasks with minimal supervision. Must have good interpersonal skills to interact with individuals in all levels of the hospital and the public. 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. Must be trustworthy and committed to confidentiality. Incumbent has access to confidential hospital, patient, and employee financial information.

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.

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