Pre-Certification Manager - Urology

Responsibilities:

• Oversee the daily Pre-Cert schedule to ensure the vendor partner and Pre-Cert team are completing the eligibility and benefits, obtaining a Pre-Cert and/or referral, and generating patient estimates in a timely and accurate fashion.
• Ensure that all cases are completed in compliance with payer policy.
• Manage the daily workload to ensure cases are worked timely and accurately, and the distribution between the vendor partner and the UUG Pre-Cert Coordinators is appropriate.
• Acts as the lead point of contact with the vendor partner and collaborates on any outstanding cases or cases at risk to avoid patient care disruptions or revenue loss.
• Audits completed cases to ensure proper procedures are followed.
• Addresses any issues relating to incorrect patient estimates.
• Partners with the Accounts Receivable team on any denials for no Pre-Cert or referral related to cases for which the Pre-Cert team is responsible.
• Prepares and updates materials in training manual and updates the vendor partner on any new payer or procedure requirements.
• Works directly with the provider's staff on any cases that are at risk and determines the appropriate steps to avoid patient care disruption or lost revenue.
• Maintains personal and team knowledge of payer policy, clinical criteria, and Pre-Cert requirements.
• Focuses on process improvement to maximize the efficiency and quality of Pre-Cert team.
• Participates in new procedure workflow development and creates training materials to support the process.
• Additional responsibilities as assigned to help drive our mission of improving the lives of everyone living with cancer.
• Required or Preferred Qualifications:
• Minimum High School Diploma or GED required.
• Minimum of five (5) years Pre-Certification, Medical Front Office, or Medical Billing experience.
• Experience working from home or in a remote capacity is highly preferred.
• Essential Competencies:
• Excellent customer service skills.
• Superior leadership, problem-solving, team building, and decision-making skills.
• Ability to effectively manage tasks and meet deadlines while working independently.
• Excellent written, verbal, and interpersonal communication skills, especially in a virtual work environment.
• Attention to detail and willingness to learn and apply constructive feedback.
• Proficient knowledge of Medical Terminology, ICD, and CPT Codes.
• Proficient computer software and database skills.
• Strong attention to detail.
• Ability to deliver high-quality results and achieve goals while working remotely.
• Collection background is a plus.
• Urology background is a plus.
• Ability to type a minimum of 40 words per minute.
• Attendance is an essential job function.
• This job description does not contain a full listing of activities, duties or responsibilities required of this role. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.
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