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Pre-Certification Coordinator – RN/LVN Required

Cantex Continuing Care Network

This is a Full-time position in Addison, TX posted July 8, 2021.

Diversity, Equity, and Inclusion are at the heart of Cantex. We are committed to a culture that respects our differences and values the contributions of all people.

Job Summary:

Objective of the Managed Care Pre-Certification Coordinator position is to seek Pre-Certifications on the Managed Care patients in their assigned facilities. The Pre-certification Coordinator serves as the point of contact between the payor and the facility during the admission phase of the care delivery process.

Essential Functions:

  • Verifies eligibility of members and participating status of providers
  • Determines member benefit coverage
  • Performs telephonic or online pre-certifications for inpatient SNF authorizations for outpatient therapy for all managed care referrals for their assigned facilities.
  • Contacts facility providers, Business Office, Sales and Marketing Liaison, and Regional Case Manager electronically with all certification and denial information
  • Analyzes information required to complete pre-certifications/authorizations with managed care health plans
  • Accurate and pertinent clinical data and demographics is compiled and communicated to the patients’ insurance company in a timely and organized fashion
  • Assembles and ensures a timely transmission of all required documentation to the health plan, pursuant to the plan’s requirements
  • Negotiates appropriate level of care for patient. Ensures all necessary authorizations are procured for treatment, equipment, medications, out of network physician coverage, etc.
  • Timely follow-up with insurance carriers is performed to obtain certification/authorization documentation for inpatient and outpatient services
  • Knowledge of insurance company criteria for inpatient admission and outpatient therapy is current
  • Comprehension of insurance data, benefits, in/out of network issues, notification requirements, predetermination services, and medical diagnosis is consistently demonstrated in order to ensure that all pre-certifications/authorizations are completed prior to the date of service
  • Sound judgment is consistently demonstrated as to when to involve physician or other health care professionals in the pre-certification/authorization or denial process
  • Trends occurring in pre-certifications/authorizations are examined and communicated in a clear, concise and professional manner for timely process improvements
  • Maintains Managed Care Referral Log at all times. This log is then used by the Precertification Coordinator to generate weekly metrics to the Director.

Qualifications:

  • Texas RN/LVN Required
  • Minimum of 3 years health care experience at a provider level or Managed Care Organization
  • Demonstrated knowledge of precertification process and intake referral for Managed Care.
  • At least one year managed care pre-certification experience, including navigating websites for online benefit reviews
  • Familiar with basic medical terminology
  • Ability to use printer, copier and facsimile machines
  • Proficient in Word and Excel
  • Multi-tasking and phone skills
  • Effective communication and interpersonal skills
  • The ability to prioritize work load
  • Strong organizational and follow up skills
  • Ability to work in a matrix reporting system
  • Ability to function effectively in multi-faceted systems and to interact effectively with all levels of staff and customers

If you are interested in this position, please submit your resume for consideration.

We are an Equal opportunity employer; We offer an excellent benefit plan to include 401K with match, CEU reimbursement, vacation, sick, holidays, medical, dental, and supplemental insurance Plans as well as a Highly competitive compensation package.