COORD, PRE-CERT - Full Time

Job Description

Job ID: 1194988
Employment Status: Full-Time
Your Career. Made Better.

Memorial Hospital Belleville is located in a well-established west Belleville neighborhood at 4500 Memorial Drive, Belleville Illinois. In addition, we have diagnostic centers in O'Fallon, Illinois, and an off-campus physical therapy center in east Belleville.  As a member of BJC HealthCare, Memorial Hospital Belleville provides full and part-time employment for more than 2300 people.
 
Facts at a Glance:                                                                    
•Accredited by Healthcare Facilities Accreditation Program (HFAP)
•Members, Illinois and American Hospital Associations
•Licensed by the State of Illinois Department of Public Health
•IDPH designated Regional Hospital Coordination Center for the Edwardsville Public Health and Medical Response Region
•Serving the healthcare needs of area residents since 1958
•Designated Magnet™ facility by the American Nurses Credentialing Center (ANCC)
•Accredited Chest Pain Center with PCI by the Society for Chest Pain Centers
•IDPH designated Stroke-Ready Hospital
•Medical staff with more than 400 members representing 42 specialties


Join Us!


Role Purpose

Works in coordination with other departmental and hospital staff to ensure reimbursement for care rendered by facility including pre-certification with external and on-site reviewers for tests and procedures. Responsible for completing the necessary data elements in a timely and efficient manner in order to financially clear all patients prior to their scheduled visit and all inpatient encounters.


Responsibilities

  • Authorizations (inpatient, ancillary and surgery): Contacts provider offices, payors and/or payor websites to secure and validate authorization information. A review of medical records may be required if initiating the authorization request directly with a payor. Follow up on post review of insurance
    mismatch.
  • Complete quality review of all inpatient encounters to
    ensure financial clearance to avoid reimbursement delays.
  • Collaborates with case management department and third party payors to ensure timely notification of inpatient encounters.
  • Utilize payor logs and various reports to ensure all authorization documentation is accurate and complete for financial clearance. Provides additional follow-up and coordination between case management and payors to obtain clinical information to finalize authorization.

  • Minimum Requirements

     

    Degree

  • High School Diploma or GED
  •  

    Experience

  • 2-5 years
  •  

    Supervisor Experience

  • No Experience

  •  

    Preferred Requirements and Additional Job Information

     

    Degree

  • Bachelor's Degree

  • Benefits Statement

    Note: not all benefits apply to all openings

    -  Comprehensive medical, dental, life insurance, and disability plan options
    -  Pension Plan*/403(b) Plan
    -  401(k) plan
    -  Tuition Assistance
    -  Health Care and Dependent Care Reimbursement Accounts
    -  On-Site Fitness Center (depending on location)
    -  Paid Time Off Program for vacation, holiday and sick time

    *Pension does not apply to Memorial Hospital, Memorial Hospital East, Memorial Medical Group, Alton Memorial or Parkland Health Center


    Legal Statement

    The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.

     

    Equal Opportunity Employer