Precertification Specialist

DescriptionPOSITION SUMMARY:

This position is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with our providers, transcribes and triages patient calls to physicians, coordinates patient appointments/orders.

KEY RESPONSIBILITIES

Review chart documentation to ensure patient meets medical policy guidelines.
Prioritize incoming authorization requests according to urgency.
Obtain authorization via payer files to include up to date requirements needed to successfully to 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 as assigned
Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.
Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
Request and follow up and secure prior-authorizations prior to services being preformed
Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations
Communicate any insurance changes or trends among them
Maintains a level of productivity suitable for the department
Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
Other duties as assigned

QualificationsQUALIFICATIONS

MINIMUM EDUCATION

High School Diploma or GED

PREFERRED EDUCATION

Knowledge of medical terminology
Familiarity with different insurance types

MINIMUM EXPERIENCE

1 year experience in a medical related field required
Previous experience in a clinic setting

PREFERRED EDUCATION

1 Year pre-certification or pre-authorization experience preferred