Pre-determination/Pre-certification Coordinator 3

Details

Posted: Unknown

Location:

Salary:

Summary:

Summary here.

Details

Posted: 27-Jan-26

Type: Full-time

Categories:

Healthcare
Staff/Administrative

Internal Number: R143453

Scope of Position

The Revenue Cycle for The Ohio State University Wexner Medical Center is responsible for providing excellent customer service, both internal and external, while processing authorization requests to insurance carriers efficiently and accurately. Areas within the Revenue Cycle include pre-registration, registration, pre-certification, financial clearance and counseling, financial assistance, scheduling, billing, claims follow-up, customer service and cash collection. The primary responsibility of staff with Revenue Cycle is to ensure the collection of net accurate, timely, revenue for services rendered.

Position Summary

The Predetermination / Precertification Coordinator implements and supports the mission, values, standards, policies and procedures of The Ohio State University Wexner Medical Center (OSUWMC). Provides exceptional customer service while ensuring the financial viability of OSUWMC. Functions within the multidisciplinary team to secure complex pre-authorizations and prevent / appeal clinical denials. The job requires the utilization of clinical knowledge to interpret and apply medical necessity guidelines to determine appropriate services. The role requires subject matter experts (SME) for insurance carriers as well as governmental payers.

This position is responsible for providing consumers (clinical staff and patients) with accurate, up-to-date information regarding insurance benefits, and authorizations. Assures accurate appointment, demographic and

insurance information is gathered to support clinical and financial needs including changes to insurance or other patient information. Provides support to physicians and customers by coordinating their requests and satisfying their needs in one transaction. Solves routine and complex customer problems and knows where to direct customers to address specific questions. Communicate regularly with clinical team, medical staff and other team members within the product/service line to ensure customer and department needs are met. The precertification department uses a variety of tools and communication methods to obtain authorization and must be able to determine the most appropriate method of contact. This includes but is not limited to electronic transactions, numerous web portals, phone calls, and faxes. Flexibility and continuous ability and willingness to learn new technology as it becomes available are essential. Must be able to use a variety of software packages which include the Electronic Medical record, scheduling and registration systems, ABN, eligibility, document management software, etc.

Minimum Qualifications

Required: High School diploma or GED. Certification or vocational training may be required. Associate degree in relevant field may be preferred. 2 years of relevant experience required. 4-6 years of relevant experience preferred.

Preferred: Associate or bachelors degree in health-related field. Experience with Windows, Excel, and Intranet/internet navigation tools as well as system content. Medical terminology, coding, and third-party reimbursement experience. Ability to work in multiple systems for assigned tasks, management, and reporting. Strong problem-solving and presentation skills. High level of customer service skills. Able to prioritize and coordinate multiple tasks in a busy environment.

Ongoing requirements: Demonstrates competency in daily functions, interpersonal and cognitive skills required to meet essential job functions. Maintains knowledge related to product/service line, quality improvement, cost reduction, current registration and billing policy and procedures as well as scheduling policies and procedures. Must maintain proficiency in utilizing all applicable systems. Must meet mandatory educational and health requirements, as well as ongoing scheduling and registration competencies. Attends Health System and Departmental In-services, education forums, and meetings as required.

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