**Description** Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work? **SUMMARY:** The Insurance Pre-Cert Coordinator obtains pre-certifications and referrals for inpatient, outpatient, prescriptions and same day encounters. The coordinator is responsible for verifying benefits and pre-certifying selected admissions, RX's and outpatient registrations. The coordinator provides specialized support in the areas of insurance and billing information and supports the representatives’ solving problems and answering questions. This position will ensure access to integrated health care; achieve clinically appropriate authorizations to assure optimal reimbursement for services provided. **ACCOUTABILITIES:** • Reviews physician and chemo schedules in advance and determines patients' insurance requirements for pre-cert, patient payments, coverage limitation and determines necessary actions prior to patient arrival. • Assesses information for appropriateness of setting and utilization of resources to optimize patient outcomes and cost effectiveness. • Maintains communication with, and provides education to, all involved departments included but not limited to admissions, business office, case managers and medical staff, nursing and designees. • Provides required clinical and demographic information to payer to obtain precertification and assure reimbursement. • Communicates with patients to verify incomplete insurance information and reminds the HMO patients to obtain a referral and make patient aware of any co-pays. • Pre-certifies and obtains authorization numbers, medical, ICD-9 and CPT codes and enters into Epic insurance flowsheet. • Interacts with medical staff and their designees to obtain complete, accurate, timely clinical and financial information required for payer reimbursement. • Sends all information required to insurance companies to ascertain an authorization number for pre-cert. • Assists admissions representative in obtaining pre-cert and authorization numbers. • Keeps representatives apprised of any changes in the process or of any new and improved methods of obtaining insurance authorizations internet, and insurance portals. • Follows up with all review companies on all pending authorizations and referrals. • Checks-out patient appointments daily in Epic and views tests orders. • Pre-registers appointments 24 hours in advance of patient's appointment. • Maintains excellent working relationships with all insurance companies, referring to physicians and their staff. • Completes work approximately one week in advance whenever possible. • Provides accurate information to billing and outside carriers to assure payment of claims. • Maintains current knowledge about pre-certification process for all Federal, State, and 3rd party payors. • Identifies systems issues impacting on the use of resources. • Shares resources and information across boundaries to ensure customer needs are met and the status of the revenue cycle is maximized. • Supports proactive communication to enable high performance of all individuals. • Escalates concerns and issues appropriately to management. • Follow professional and proper telephone etiquette using interpersonal skills and required job knowledge. **EDUCATION/EXPERERIENCE:** Required H.S. Diploma/GED Or equivalent required and 3+ years’ experience in a healthcare environment or education in lieu of experience (Associate's or Bachelor's degree) Previous registration experience with a thorough understanding of third party insurance coverageWe believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives. Live Your Life's Work We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law. REQNUMBER: 274569