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Job Details

Financial Precert Specialist

Requisition #: 196238
Location: Johns Hopkins Health System, Baltimore, MD 21201
Category: Clerical and Administrative Support
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Nov. 12, 2019

Reporting to the Patient Financial Services Director of Operations, the Precertification Specialist will be responsible for performing precertification functions which include obtaining and presenting clinical documentation to payers to in an effort to obtain admission authorization and ensure reimbursement for the patient’s admission.

Critical to this position is the review of medical records, documentation of authorization statuses and processes, communicating detailed clinical information to relevant parties. The incumbent will interact with Medical Director to request peer-to-peer review. In addition, the precertification specialist will act as a clinical resource for non- clinically oriented co-workers.

Education:

  • Completion of an accredited nursing program; Bachelor’s degree required, Master’s degree preferred

Required Licensure Certification, etc.

  • Licensed in the State of Maryland as a Registered Nurse (RN)

Work Experience:

  • Requires three to five years clinical experience as staff nurse with broad range of clinical experience
  • Experience in utilization management or in payer environment preferred

Knowledge:

  • Knowledge of medical terminology, anatomy and physiology ,diagnoses, surgical procedures, and basic disease processes
  • Analytical ability to gather data, decide on conformity based on predetermined criteria, identify problems and refer resolution
  • Awareness of licensing and accreditation standards
  • Familiarity with precertification and utilization management methodologies, applications and theory
  • Familiarity with Microsoft Office including XL spreadsheets
  • Evaluates adequacy of documentation and ability to conduct research of issue at hand, as well as, formulate recommendations based on findings
  • Capable of providing in-service education to healthcare providers and Patient Financial Services(PFS) inpatient clearance staff
  • Ability to recommend ICD and CPT codes to account managers for urgent cases and when not provided for elective cases
  • Ability to identify incorrect codes or verbiage provided by Medical Office Coordinators (MOCs), provide corrections to MOC
  • Ability to discuss patient cases with precert nurses and medical directors
  • Ability to identify cases without ICD and CPT codes, request from MOC, and provide information to PFS Financial Clearance Supervisors

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Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age national origin, disability, protected veteran status and or any other status protected by federal, state or local law.

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