Precertification/Authorization Specialist-1

Medical University of South Carolina • Bluffton, MN

99d

About The Position

Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care, via phone, fax, or payer websites. The Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. Other duties as assigned.

Requirements

• High School Degree or Equivalent.
• 1 year of relevant work experience.

Responsibilities

• Verify eligibility and obtain insurance benefits.
• Ensure pre-certification, authorization, and referral requirements are met.
• Determine which patient services have third party payer requirements.
• Obtain necessary authorizations for care via phone, fax, or payer websites.
• Provide detailed and timely communication to payers and clinical partners.
• Document appropriate information in the patient's record.

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees