Precertification Clinical Specialist

Serves as the primary clinical resource in the PreCertification Department for the handling of complex authorization issues. Responsible for clinically assessing all adverse determinations made by insurers through all levels of the Pre-Service Administrative appeals process. Supports the Patient Access team (both management and staff) to ensure precertification/authorization issues are investigated and handled expeditious and thoughtfully from an administrative, technical and clinical perspectives. Serves as the primary liaison between the Precertification Department and staff Physicians in regard to authorization
issues. Supports the Infusion, Radiation Therapy, Surgical, and Diagnostic Imaging Precertification Teams. Responsible for reviewing financial/insurance information obtained during the financial clearance process to determine payer requirements are met by obtaining the appropriate referrals, pre-certification/authorization for payers in order to optimize reimbursement and avoid payment penalties.

Education
Other \: Graduate of an accredited RN program (Required)
Bachelors Degree \: Nursing or other clinical health care field (Preferred)

Experience
3 Years recent experience with Utilization Review in a hospital or in insurance company setting (Required)
2 Years experience in oncological authorization/precertification (Preferred)
General Experience in working with utilization review standards (Preferred)

License/Certifications
RN-LIC - PA Registered Nurse License (Required)
CPUR - Cert Prof Utilization Review (Preferred)
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Your Tomorrow is Here!

Temple Health is a dynamic network of outstanding hospitals, specialty centers, and physician practices that is advancing the fight against disease, pushing the boundaries of medical science, and educating future healthcare professionals.  Temple Health consists of Temple University Hospital (TUH), Fox Chase Cancer Center, TUH-Jeanes Campus, TUH-Episcopal Campus, TUH-Northeastern Campus, Temple Physicians, Inc., and Temple Transport Team.  Temple Health is proudly affiliated with the Lewis Katz School of Medicine at Temple University.

 

To support this mission, Temple Health is continuously recruiting top talent to join its diverse, 10,000 strong workforce that fosters a healthy, safe and productive environment for its patients, visitors, students and colleagues alike.  At Temple Health, your tomorrow is here!

Equal Opportunity Employer/Veterans/Disabled

An Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

 

Your Tomorrow is Here!

Temple Health is committed to setting new standards for preventing, diagnosing and treating major diseases in our community and across the nation.  Achieving that goal means investing in our employees' success through staff and leadership development.  Our recruitment strategy is to attract and retain a diverse, high performing workforce that fosters a healthy, safe and productive environment for our patients and colleagues alike.