Pre-Certification Specialist

Description

Coordinate and conduct pre-admission reviews for all scheduled and urgent (non-same day) inpatient admissions, short stays and extended recovery patients. Determine appropriate level of care based upon clinical review, medical necessity criteria and institutional patient placement guidelines. Complete all aspects of the pre-authorization process and negotiate the appropriate level of care for services within required timeframes. Assign ICD-10 and CPT codes for planned procedures/treatments and provide to payers as required. Utilize preliminary codes to identify procedures requiring inpatient status or insurance authorizations to assure timely and accurate reimbursement. Extract pertinent clinical information from the electronic health record and provide to payers utilizing payer specific communication protocols. Document all actions, contacts, outcomes and interventions to assure appropriate payment of claims and assist with potential appeals. Conduct admission and discharge medical necessity reviews for the Obstetric-Labor and Delivery population of patients admitted to the hospital and ensure all authorization and payer requirements are met. Under FLSA, incumbents in this position are nonexempt.

Movements To

The list below shows actual job titles that staff moved to when they were in the position you selected and the frequency of occurrences. This data has been collected since September 1, 2005, and continues to expand as time goes on.

Movements To
U-M Job Title	Frequency	Role	Open Jobs
Administrative Assistant Senior Healthcare	4	Professional	6
Clinical Documentation Specialist	2	Professional	0
Medical Coder Outpatient	1	Professional	0
Patient Services Intermediate	3	Professional	12
Utilization Review Appeals Specialist	3	Professional	0

Movements From

The list below shows actual job titles held by staff when they moved into the position you selected and the frequency of occurrences. This data has been collected since September 1, 2005, and continues to expand as time goes on.

Movements From
U-M Job Title	Frequency	Role	Open Jobs
Office Manager	1	Managerial	0
Patient Business Associate	11	Professional	0
Patient Registration Specialist	1	Professional	2
Patient Services Associate	13	Professional	17
Patient Services Intermediate	7	Professional	12
Senior Billing Clerk/Senior Patient Accounts Representative Healthcare	35	Professional	3
Utilization Review Appeals Specialist	1	Professional	0
Utilization Review Technician	1	Professional	0

Paths Within Bands

Paths Within Bands
Path Level	U-M Job Title	Career Band	Role	Open Jobs
HA100	Medical Records Clerk	Health Information Management	Professional	0
HA110	Medical Records Technician	Health Information Management	Professional	0
HA130	Health Information Analyst	Health Information Management	Professional	1
HA130	Medical Transcriptionist	Health Information Management	Professional	0
HA140	Medical Records Research Coordinator	Health Information Management	Professional	0
HA150	Health Record Analyst	Health Information Management	Professional	0
HA150	Medical Coder Non-Certified	Health Information Management	Professional	0
HA150	QA Transcription Analyst	Health Information Management	Professional	0
HA160	Cancer Registrar	Health Information Management	Professional	0
HA160	Cancer Registrar Non-Certified	Health Information Management	Professional	0
HA160	Medical Coder Outpatient	Health Information Management	Professional	0
HA160	Pre-Certification Specialist	Health Information Management	Professional	2
HA170	Medical Coder Inpatient	Health Information Management	Professional	0
HA170	Medical Information Supervisor	Health Information Management	Managerial	0
HA170	Medical Records Administrator RHIT	Health Information Management	Professional	0
HA170	Medical Transcription Supervisor	Health Information Management	Managerial	0
HA170	Mental Health Case Manager	Health Information Management	Professional	0
HA180	Diagnosis Related Group Coordinator	Health Information Management	Professional	0
HA180	Medical Coder Compliance Specialist	Health Information Management	Professional	0
HA180	Medical Records Coding Services Supervisor	Health Information Management	Managerial	0
HA180	Utilization Management Coordinator	Health Information Management	Professional	0
HA180	Utilization Review Technician	Health Information Management	Professional	0
HA190	Clinical Documentation Specialist	Health Information Management	Professional	0
HA190	Clinical Information Analyst Associate	Health Information Management	Professional	0
HA190	Health Information Management Supervisor	Health Information Management	Managerial	0
HA200	Clinical Information Analyst Intermediate	Health Information Management	Professional	2
HA200	Medical Information Services Manager	Health Information Management	Managerial	0
HA200	Utilization Review Appeals Specialist	Health Information Management	Professional	0
HA210	Clinical Information Analyst Senior	Health Information Management	Professional	2
HA210	Clinical Information Reporting Senior	Health Information Management	Professional	0
HA210	Health Data Analyst Lead	Health Information Management	Professional	0
HA210	Health Information Management Manager	Health Information Management	Managerial	0
HA220	Clinical Information Analyst Lead	Health Information Management	Professional	1
HA220	Health Information Management Senior Manager	Health Information Management	Managerial	0
HA230	Clinical Information Analyst Staff Specialist	Health Information Management	Professional	1
HA230	Medical Information Administrator	Health Information Management	Professional	0
HA240	Health Information Services Director	Health Information Management	Managerial	0
HA250	Health Information Management Top Executive System	Health Information Management	Managerial	0

Pre-Certification Specialist

Description

Job ID

Career Family

Career Band

Role

Path Level

Careers Postings