Precertification Specialist

Pre-certification Specialist

Job Description

The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers.

Responsibilities:

• Review chart documentation to ensure patient meets medical policy guidelines
• Prioritize incoming authorization requests according to urgency
• Obtain authorization via payer website or by phone and follow up regularly on pending cases
• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
• Initiate appeals for denied authorizations
• Respond to clinic questions regarding payer medical policy guidelines
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Contact patients to discuss authorization status
• Other duties assigned

KNOWLEDGE, SKILLS AND ABILITIES:

• 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, specifically musculoskeletal
• Proficient use of CPT and ICD-10 codes
• Excellent computer skills including Excel, Word, and Internet use
• Detail oriented with above average organizational skills
• Plans and prioritizes to meet deadlines
• Excellent customer service skills; communicates clearly and effectively
• Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
• EMR experience needed. EClinical (ECW) experience a plus.

EDUCATION, LICENSE, OR CERTIFICATION REQUIREMENTS:

• High School Diploma or equivalent
• 2 years medical prior authorization experience preferred
• 2 years experience in a medical related field required
• Computer proficiency, including Excel, Word, Publisher, and PowerPoint required

BENEFITS:

• Medical, Dental and Vision Insurance begins day 1.
• Profit sharing and 401(k) benefits
• Paid company holidays
• PTO accrual

Salary: Based on experience, skills and knowledge. Ranges from $15.00 to $18.00

Benefits:

• 401(k) matching
• Health insurance
• Life insurance
• Paid time off

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: One location