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CommonSpirit Health Pre-Authorization Rep in CHATTANOOGA, Tennessee

Overview

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

Responsibilities

Job Summary:

Responsible for insuring the necessary pre-certifications are obtained to receive proper reimbursement for scheduled cardiac imaging performed. Each case is evaluated individually to determine the appropriate precertification requirement based on established criteria.

Essential Responsibilities:

  • Responsible for obtaining all pre-authorizations for planned outpatient cardiac imaging ordered by Chattanooga Heart Institute providers throughout the practice.

  • Interact with coding staff to ensure that medical necessity requirements are met.

  • Ensure timely updates of payer coverage.

  • Maintain vendor and payer worksheets for all cardiac imaging modalities.

  • Track and reconcile pre-authorization denials for process improvement.

  • Notify Manager/Director of documentation improvement opportunities.

  • Utilize payer website to obtain precertification electronically or via phone calls per company guidelines.

  • Interact with physicians and assist with peer to peer calls.

  • Provide timely and accurate feedback to Manager - Revenue Cycle should precertification issues arise.

  • Provide timely and accurate precertification approval information to the hospital prior to patients' appointments.

Qualifications

Education:

  • High school diploma or equivalent.

Qualifications:

  • Two years' experience with pre-certifications and/or referrals.

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CommonSpirit Health participates in E-verify.

Requisition ID 2021-148880

Employment Type Full Time

Department Cardiology Clinic

Hours / Pay Period 80

Facility Memorial Heart Institute LLC

Shift Day

Standard Hours Monday - Friday (8:00 AM - 5:00 PM)

Work Schedule CHI Not Applicable

Location TN-CHATTANOOGA

Equal Opportunity CommonSpirit Healthâ„¢ is an Equal Opportunity/ Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law.

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