Precertification/Authorization Specialist

Medical University of South Carolina•Charleston, SC

23h

About The Position

Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met before inpatient, outpatient, and ancillary services are delivered. Determines which patient services have third-party payer requirements and obtains necessary authorizations for care by phone, fax, or payer websites. Provides detailed and timely communication to payers and clinical partners to facilitate compliance with payer contractual requirements, and documents appropriate information in the patient's record. Other duties as assigned. The position is with the Medical University Hospital Authority (MUHA), in the Precertification Unit. It is a regular employee role with 40 scheduled hours per week and hourly pay.

Requirements

High school degree or equivalent.
One year of work experience.

Responsibilities

Verify patient eligibility and obtain insurance benefits.
Determine which patient services have third-party payer requirements.
Obtain necessary authorizations for care by phone, fax, or payer websites.
Ensure pre-certification, authorization, and referral requirements are met before inpatient, outpatient, and ancillary services are delivered.
Communicate detailed and timely information to payers and clinical partners to facilitate compliance with payer contractual requirements.
Document appropriate information in the patient's record.
Perform other duties as assigned.