Medical Office PreCertification Specialist

North American Medical Associates • Hainesport, NJ

12h

About The Position

Job Summary: The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all payers. Company Overview: NASPAC is a growing organization with a team of doctors and professionals devoted to the art of pain management: diagnosing, managing, and treating chronic pain conditions and neurological disorders. We also aim to go beyond treatment of pain, to improve your quality of life and productivity. Essential & Non-Essential Job Functions/Position Responsibilities: The Precertification Specialist performs a wide range of duties, including, but not limited to the following: 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. Knowledge, Skills and Abilities Requirements: 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.

Requirements

• 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.
• 2 years medical prior authorization experience preferred.
• 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.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed