Central Ohio Primary Care is seeking a Precertification Manager at our central business office in Westerville, OH. The Precertification Manager is responsible for overseeing the processing of orders for high tech radiology, cardiac testing and medication prior authorizations to be performed at Central Ohio Primary Care. This position works closely with ordering providers to ensure quality and timely patient care.

POSITION(S) SUPERVISED: Precertification Assistants

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Oversee and monitor high volume of work. Provide direction to staff and act as a resource to staff and practices to answer questions/requests.

• Responsible for training and onboarding new employees. Provide additional training resources to current employees as needed.

• Manage scheduling and PTO requests for staff.

• Collaborate with team to distribute workload and prioritize department needs.

• Create structure and procedures when insurance plans change. Collaborate with management to identify improved efficiencies. Implement changes across department.

• Monitor team production by running reports and conducting audits.

• Address process issues and group denials by working with health plan liaisons as needed.

• Work closely with Revenue Cycle department on processing denials and research reason for denials. Work on appeals as needed.

• Work with physicians on missing information or denials.

• Assist with processing routine and urgent orders in a timely manner.

• Verify insurance eligibility, complete pre-certifications as needed.

• Compile all clinical data needed to support the criteria set forth by each payor’s guidelines.

• Communicate with the ordering provider if additional clinical is needed before submitting request.

• Follow up on pending cases, respond to assigned telephone encounters, accurately document all activity of the case.

• Attend department and other related meetings.

• Other duties as assigned by management.

QUALIFICATIONS:

Required: 5 years of precertification experience

Required: Clinical background

Preferred: Previous experience working in a supervisory or lead role

Preferred: Bachelor’s degree in related field; high school diploma required

Knowledge, Skills & Abilities

• Excellent verbal & written communication skills

• Knowledge of Microsoft Teams, Word, Excel and Outlook.

• Ability to manage a team in a fast-paced environment.

• Ability to act as a problem solver.

• Ability to multitask.

• Ability to execute job duties with precision and attention to detail.

• Ability to work both independently and together as a team.

• Ability to prioritize and organize work efficiently to complete work timely.

• Strong time management skills.

• Strong communication skills with internal and external customers.

• Possess a positive attitude.

• Possess strong problem solving, critical thinking skills.