Overview Job Summary 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 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. Required Population Served Job Responsibilities Job 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. • Precertifies 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. • Communicates recommendations, clinical information, and fiscal information to appropriate internal and external customers in order to facilitate optimal delivery of services and customer satisfaction. • Participates in the planning, data collection, and analysis phases of performance improvement activities in order to maximize the patient placement/precertification process. • Completes assigned goals. Specifications Experience Description Minimum Required Preferred/Desired 5 years of business/clinical experience in a healthcare setting with a focus in patient access, business office, and/or case management areas. 8 years of business/clinical experience in a healthcare setting with a focus in patient access, business office, and/or case management areas. Education Description Minimum Required Preferred/Desired Associates degree or equivalent years of work experience. Bachelors degree or equivalent years of work experience. Training Description Minimum Required Preferred/Desired Special Skills Description Minimum Required Preferred/Desired Excellent communication skills. Advanced computer literacy skills. Excellent communication skills. Advanced computer literacy skills. REQNUMBER: 32808