• Leads the pre-certification section in daily activities and prioritization of assignments • Assists in adjusting daily assignments based on coverage needs of the team and unit • Answers the pre-certification phone lines; assists with billing inquiries, insurance questions, and missing order and pre-certification issues • Acts as liaison between department facilities and physician offices • Contacts appropriate insurance companies for benefit verification and pre-certification of procedures and testing • Supplies all documentation required during pre-certification process to insurance companies • Documents when pre-certification is received from insurance companies and maintains open communication with physicians and their assistants regarding concerns or when physician involvement is needed • Provides training and education to staff • Assists staff with complex cases avoiding denials and physician peer to pears • Reviews denials to see if there is a potential for re-consideration • Provides feedback to management regarding staffing concerns and process improvement

• Completes pre-certifications for complex and specialized services as indicated on therapy and treatment plans • Reads and analyzes therapy and treatment plans, drug protocols, and clinical documentation • Completes authorization process with the payer and in EPIC • Completes rechecks on existing pre-certifications by verifying insurance eligibility • Works with clinical staff and providers on add-ons, denials and peer to peers through to resolution • Performs other duties as assigned

• Completes pre-certifications for complex and specialized services as indicated on therapy and treatment plans • Reads and analyzes therapy and treatment plans, drug protocols, and clinical documentation, as well as payer policies and patient benefits • Completes the authorization process with the payer and in EPIC • Completes rechecks on existing pre-certifications by verifying insurance eligibility and all authorization information for all applicable services • Confirms all recheck information is documented in EPIC • Works with clinical staff and providers on add-ons, denials and peer to peers through to resolution • Performs other duties as assigned, such as assistance with denials, rejections and appeals

• Initiates and facilitates pre-determination process • Contacts insurance companies for benefit verification and pre-certification • Notifies financial counselor for pre-payment of un-coded services • Maintains daily surgery/procedure schedule for department faculty • Maintains communication with physicians regarding their schedules • Keeps a written log of all pre-certifications in process • Notifies hospital utilization/billing department of pre-certification • Documents when pre-certification is received from insurance companies • Performs other duties as assigned