Medical Office PreCertification Specialist

North American Medical Associates•Hainesport, NJ

About The Position

North American Medical Associates is a fast growing multi-speciality medical practice with a team of doctors and professionals devoted to the art of diagnosing, managing and treating disorders. We also aim to go beyond treatment to improve quality of life and productivity. The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all payers.

Requirements

2 years experience in a medical related field required.
Minimum of 5+ years of experience working in a call center or other customer service-related position.
Highly proficient in Microsoft Office and knowledge working with Electronic Medical Records.
Ability to clearly communicate issues to all levels of management.
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 authorization 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; communicated clearly and effectively.
Ability to multitask and remain focused while managing a high-volume, time-sensitive workload.

Nice To Haves

2 years medical prior authorization experience preferred.

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 diagnosis in the procedure order.
Contact patients to discuss authorization status.
Other duties as assigned.