In an environment of continuous quality improvement, the Precertification Assistant is responsible for assisting with the review of scheduled tests and surgeries, to verifying insurance information and coverage, determine authorizations, medical necessity is obtained, or medical coverage, for proper payment of testing. Exhibits the MHS Standards of Excellence and exercises strict confidentiality at all times.

 

Job Functions:

Acquires skills and maintains knowledge of system applications/websites used in precertification. Determines if test/procedure requires authorization. Reviews order for completeness. Obtains appropriate authorization, checks medical necessity for Medicare patients, reviews Commercial Insurance medical policies to ensure proper payment from Insurance is received. Contacts the provider’s office via telephone or task to place a patient’s testing on hold if authorization isn’t obtained. Notifies the providers office if a Peer to Peer option is available. Tracks authorization information in all tabs of the authorization module. Assumes all other duties and responsibilities as necessary.