Precertification Specialist II - Utilization Mgmt- Varies - PRN

Memorial Hospital at Gulfport•Gulfport, MS

About The Position

The Precertification Specialist II is responsible for overseeing the completion of authorizations. The Specialist acts as the liaison between providers, physicians, insurance companies, billing department, and utilization review companies to ensure the initiation and/or completion of all payers requiring precertification

Requirements

Education: High School Diploma or GED equivalent.
Experience: Two (2) years of experience with precertification and insurance verification in a hospital or healthcare setting OR completion of LPN/RN program.

Responsibilities

Obtains, verifies, and assists in the completion of authorization
Monitors a listing of scheduled procedures to begin and complete the authorization process
Reviews clinical records for supporting documentation and submits to obtain authorization
Documents accounts and charts with updated authorization statuses based on final payer responses
Completes authorizations with no more than five incomplete authorizations within a one-year period
Receives communication from providers and/or the provider’s staff when procedures are ordered for outside facilities
Acts as a liaison with physician offices, insurance companies, and utilization review companies
Reports denials and works with providers to appeal as the providers sees fit
Gathers information requested by providers and assists by prefilling forms
Communicates with providers regarding incomplete documentation, peer-to-peer review requests, denials and appeals
Works in conjunction with billing departments to obtain authorizations post service initiation
Examines past procedures for performed testing with missing authorizations
Submits clinical documentation for retroactive or upgraded authorizations
Collaborates with billing to obtain authorization when denials or audits are necessary due to final payer response