Clinical Admin Coordinator

Allmed Staffing•Sumter, SC

16h•Hybrid

About The Position

The Precertifier Team Member is responsible for obtaining prior authorizations and pre-certifications for diagnostic testing, procedures, medications, and specialty treatments. This position works closely with providers, patients, insurance companies, and ancillary departments to help ensure timely access to medically necessary services while meeting insurance and organizational requirements.

Requirements

High school diploma or equivalent.
Strong organizational and time-management skills.
Excellent verbal and written communication skills.
Ability to manage multiple priorities in a fast-paced healthcare environment.
Strong attention to detail and follow-through.
Ability to work independently and as part of a team.
Understanding of patient confidentiality and HIPAA requirements.

Nice To Haves

Associate degree.
Previous experience with prior authorizations, pre-certifications, or medical insurance verification.
Healthcare administration experience.
Knowledge of medical terminology and diagnostic testing.
Experience with specialty medication authorization processes.
Familiarity with EMR systems and insurance payer portals.

Responsibilities

Obtain prior authorizations and pre-certifications for diagnostic testing, procedures, medications, and specialty treatments, including: MRI CT Scans Stress Tests Ultrasounds Nerve Conduction Studies Vestibular Testing (VNG) Botox Treatments Specialty and injectable medications
Verify patient insurance benefits and authorization requirements.
Submit clinical documentation and medical records to insurance carriers as required.
Monitor authorization requests and follow up with payers to obtain timely decisions.
Communicate approvals, denials, and pending requests to providers, clinical staff, and patients.
Review denial determinations and coordinate appeals when appropriate.
Maintain accurate documentation of authorization requests and outcomes within the EMR.
Ensure authorization activities comply with payer guidelines and organizational policies.
Collaborate with physicians, nurses, and ancillary departments to obtain necessary clinical information.
Track authorization expiration dates and obtain extensions when necessary.
Provide professional customer service while maintaining patient confidentiality and HIPAA compliance.