Precertification Specialist

CALDWELL COUNTY HOSPITAL INC•Princeton, KY

6d•Onsite

About The Position

This position is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with our providers, transcribes and triages patient calls to physicians, and coordinates patient appointments/orders.

Requirements

High School Diploma or GED
1 year experience in a medical related field required
Previous experience in a clinic setting

Nice To Haves

Knowledge of medical terminology
Familiarity with different insurance types
1 Year pre-certification or pre-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 files to include up to date requirements needed to successfully to obtain authorizations.
Initiate appeals for denied authorizations.
Respond to clinic questions regarding payer medical policy guidelines.
Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order.
Contact patients to discuss authorization status.
Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.
Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
Request and follow up and secure prior-authorizations prior to services being preformed.
Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
Communicate any insurance changes or trends among them.
Maintains a level of productivity suitable for the department.
Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.