Specialist-Patient Placement

Overview

Job Summary

Recommends the most efficient, cost-effective utilization of resources within the continuum of care, prior to the delivery of services. Evaluates, assesses, plans, and facilitates a plan of care. Obtains/Validates insurance prior authorizations and pre-certification for inpatient and/or outpatient healthcare services. Some overtime and call back is required. This position is under the general direction of the leadership of Centralized Patient Access or Baptist Connected Center-Corporate. Performs other duties as assigned.

Responsibilities

• Assesses and evaluates clinical and financial information available and recommends the most appropriate setting for service delivery, including level of care in order to optimize resource consumption and reimbursement.
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  Pre-certifies patient care services that require precertification, as identified, in a timely, efficient manner, in order to optimize reimbursement for the patient, as well as health care providers.
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  Communicates recommendations, clinical information, and fiscal information to appropriate internal and external customers in order to facilitate optimal delivery of services and customer satisfaction.
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  Participates in the planning, data collection, and analysis phases of performance improvement activities in order to maximize the patient placement/precertification process.
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  Completes assigned goals.

Specifications

Minimum Required

• 5 years of business/clinical experience in a healthcare setting with a focus in patient access, business office, and/or case management areas.

Preferred/Desired

• 8 years of business/clinical experience in a healthcare setting with a focus in patient access, business office, and/or case management areas.
• High School Diploma required RHIT or LPN preferred 2 yrs college preferred Computer literacy and medical terminology required.

Education

• Associates degree or equivalent years of work experience.
  Bachelor's degree or equivalent years of work experience.
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Special Skills

• Excellent communication skills. Advanced computer literacy skills.
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Minimum Required

• Working knowledge of Excel 2007 and Microsoft Office products. Comfort with data entry within Revenue Cycle software, patient management systems, and Windows based applications preferred.

Licensure

Minimum Required

Preferred/Desired

• LPN or CMA