Precertification Specialist - Patient Accounts

Location: University Commons Campus; 6301 University Commons, South Bend, IN 46635

Hours: Full Time; Hours: Monday-Thursday 8:00am-5:00pm, Friday 8:00am-4:00pm

Good enough isn’t for us. The South Bend Clinic's team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our work.

The South Bend Clinic works to understand what matters most to you. We recruit and retain team members who share a relentless passion and pride for helping others live happier and healthier lives. We invest in helping our team members develop their talents in a way that is rich in personal meaning. We invite you to join us, fulfill your purpose and make your mark!

Holistic benefits designed to help our team members flourish in all aspects of their lives, including: 

• Comprehensive medical and prescription drug benefits that include medical coverage at 100% (after deductible) when utilizing a Duly provider.
• $5,250 Tuition Reimbursement per year. 
• 40 hours paid volunteer time off. 
• A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact
• Wellness program that includes complimentary subscriptions to Noom and Calm apps. 
• 12 Weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members. 
• 401(k) Match
• Profit-sharing program

The Journeys and Adventures that Await

• Obtains insurance pre-certification for all office procedures, medications, infusions, injections, surgery, diagnostic testing, DME, imaging, and medications. 
• Performs timely documentation of status work in applicable electronic platform.
• Schedules patient procedures and/or tests with appropriate departments including involved parties.
• Obtains referrals as necessary.
• Ensures patients are informed of scheduled tests/procedures and insurance requirements prior to completion.
• Assists in benefit verification with patient insurance company so patient knows ahead of time what they will be financially responsible for, where applicable.
• Coordinates precertification and authorization processes with scheduling staff so appointments can be made in a timely manner.
• Obtains any and all pertinent clinical health information to process authorizations, referrals, and precertifications.
• Reinforces instructions and explanations of tests/procedures to patients per protocol.
• Documents all pre-certifications/authorizations in appropriate electronic platform.
• Verifies demographic information, including insurance when scheduling and/or obtaining pre-cert.
• Handles phone calls from patients regarding their insurance requirements for tests/procedures if applicable.
• Compiles necessary reports regarding pre-certification.
• Communicates with Business Office regarding verification of complex insurance and precertification requirements.
• Maintains good working relationships with all contacts. 
• Utilizes up-to-date coding information.
• Takes initiative to seek out tasks and duties or to assist others as necessary
• Exhibits computer systems knowledge and proficiency as necessary to perform job functions.
• Demonstrates the attitudes and behaviors of The South Bend Clinic Service Standards.
• Performs other duties as assigned when appropriate.
• Adheres to HIPAA guidelines set forth in Clinic policies and procedures.

POSITION REQUIREMENTS

Education/Certification/License:

High school diploma or equivalent required.

Knowledge, Skills, and Abilities: 

Minimum of 2 years of experience in a related field required. Prior computer experience and ability to navigate in systems required. Prefer previous procedure scheduling with strong knowledge of insurance requirements and prior medical office experience.  Position requires constant and frequent sound judgment and response.  Must have excellent phone communication skills; detailed focus and quality follow through; and ability to successfully multi-task.