Diagnostic Precert Specialist

Carolina Orthopaedic and Neurosurgical Associates • Duncan, SC

7d • Onsite

About The Position

Full-time precertification specialist needed for a multidisciplinary medical practice. This role involves administrative responsibilities focused on obtaining pre-certifications and authorizations for diagnostic procedures for orthopedic, neurosurgical, and pain management physicians. The ideal candidate must be detail-oriented, focused, organized, and a team player with an attitude to contribute meaningfully to the practice.

Requirements

• Able to prioritize, work accurately, work well independently and able to maintain focus under pressure
• Working knowledge of medical terminology, insurance packages/plans
• Proficient with EMR
• Clearly communicate with providers, insurance companies and staff.
• Excellent verbal and written communication skills
• Excellent organizational skills, multi-tasking capabilities and detail orientated
• Customer Services skills
• Basic Computer/PC and Internet skills
• Attention to details and problem-solving skills
• Must be a great team player
• High School Diploma (Required)

Nice To Haves

• 1 year precertification experience (preferred)

Responsibilities

• Contacts insurance companies and other third-party payers to determine preauthorization requirements for diagnostic services.
• Calls insurance companies or uses online tools to obtain preauthorization.
• Follows up timely and thoroughly.
• Ensures all preauthorization issues are communicated in a timely manner.
• Liaisons with the physician’s staff to obtain additional insurance and/or clinical information.
• Reviews patients' charts and submits appropriate and pertinent information from the clinicals for medical necessity for the service.
• Follows up properly on all denials and peer-to-peer requests.
• Documents appropriately regarding all actions, authorization, and denials.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED