Pre-Certification Specialist I (Finance)

As one of the nation's leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own. 

Equity, diversity, and inclusion guide our growth and strategy.  We are looking for individuals who are passionate about, and committed to leading efforts to provide culturally relevant care, reducing health disparities, and helping build a diverse and inclusive team environment. All Nemours associates are expected to ensure that these philosophies are embedded in their day to day work with colleagues, patients and families.

Nemours is seeking a Pre-Certification Specialist I (FULL-TIME), to join our Nemours Children's Specialty Care team in Jacksonville, Florida.

At our three clinic locations in the Jacksonville area, Nemours is a leading provider of pediatric specialty care in north Florida with many of our pediatric specialists regularly recognized as the “Best Doctors in America®.” We offer comprehensive, family-centered care in more than 30 pediatric specialties. Several of those specialties, offered in collaboration with Wolfson Children's Hospital, have been named among the best in the country by U.S. News & World Report.

Primary Functions

• Obtain precertification and enter into Epic for scheduled and urgent surgical procedures, ancillary services, hospital admissions and other hospital based services. Create Financial Advocate appointments and answer patient families questions about insurance benefits and associated out of pocket cost of procedure.
• Communicate with assigned clinics in the event  precertification is denied or request additional information when necessary. 
• Notify hospital with precertification information.
• Monitor Outlook email,  Epic in-basket, voice mail and respond in a timely manner. 
• Provide necessary coverage during other team members absence. 
• All other duties as assigned by supervisor or manager.

Work Schedule:  8:00am - 5:00pm

Performance Skills

• Use professional language and appropriate grammar at all times in verbal or written communication.
• Ability to work with minimal supervision, possess critical thinking skills and be solution oriented.
• Embraces cultural diversity in the workplace.
• Govern self by personal standards of integrity/ethics
• Organize and prioritize responsibilities in order to meet deadlines.

• Detail oriented with above average organizational skills

• Ability to multitask and remain focused while managing a high-volume, time-sensitive workload.

Job Requirements

• High School Diploma required.  Specialized (1 year of training beyond high school). 
• Minimum of one (1) to three (3) years experience required.
• CPC Preferred

• Proficient use of CPT and ICD-10 codes.

• Knowledge of procedure authorization and its direct impact on the practice's revenue cycle.

• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively.

• Basic understanding of human anatomy.

• Excellent computer skills including Excel, Word, and Internet use.

• Plans and prioritizes to meet deadlines.

• Excellent customer service skills; communicates clearly and effectively.

***EXTERNAL APPLICANTS:  Please be advised if you apply to this position, you will be asked to take an assessment as part of the application process.  This could add an additional 20 to 45 minutes, based upon the assessment that corresponds with this position.  Please allow yourself enough time to complete the test, as you will not be able to save your application and come back to complete it at a later time.  Do not use your mobile phone to apply to this position; our assessment is not compatible with mobile devices at this time ***

Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings.