Pre Authorization Rep

Job Summary:

Responsible for ensuring the necessary pre-certifications are obtained to receive proper reimbursement for scheduled cardiac imaging performed.  Each case is evaluated individually to determine the appropriate pre-certification requirement based on established criteria.

Essential Responsibilities:

• Responsible for obtaining all pre-authorizations for planned outpatient cardiac imaging ordered by Chattanooga Heart Institute providers throughout the practice.
• Interact with coding staff to ensure that medical necessity requirements are met.
• Ensure timely updates of payer coverage.
• Maintain vendor and payer worksheets for all cardiac imaging modalities.
• Track and reconcile pre-authorization denials for process improvement.
• Notify Manager/Director of documentation improvement opportunities.
• Utilize payer website to obtain precertification electronically or via phone call per company guidelines.
• Interact with physicians and assist with peer to peer calls.
• Provide timely and accurate feedback to Manager-Precertification should precertification issues arise.
• Provide timely and accurate precertification approval information to the hospital prior to patients' appointments.

Education/Experience:

• High school graduate or equivalent.
• Two years' experience with pre-certifications and/or referrals.

The Chattanooga Heart Institute offers the most comprehensive cardiac care available in this region. Founded in 1976, we now have six offices in Tennessee and one in Georgia. Our practice is made up of 29 board-certified cardiologists and three cardiothoracic surgeons. We merged with CHI Memorial Health Care System in 2011 which is part of CommonSpirit Health. CommonSpirit has more than 700 care sites across the U.S. and is committed to building healthy communities.