Precertification Specialist (Full-time, 8:30am-5:00pm)

Washington Regional Medical System • Fayetteville, AR

1d • Onsite

About The Position

The role of the Pre-Certification Specialist reports to the Scheduling Manager. This position is responsible for utilizing the electronic medical record system to abstract information to prove medical necessity to the payor and to ensure precertification for services is obtained prior to the date of service. This position is responsible for researching resolutions for authorization issues and recommends process improvement to reduce denials associated with authorizations.

Requirements

• High School Diploma or GED
• Minimum of two years’ experience in a medical setting with a focus in coding, admitting, or precertification, preferred.
• Previous experience with CPT and ICD 10 codes, preferred.

Responsibilities

• Effectively communicate with the ordering providers and/or necessary clinic staff for medical reviews and preauthorization regarding future cases
• Maintain a current working knowledge of authorization and medical necessity requirements
• Review cases for anticipated denials and schedules peer reviews
• Utilize the appropriate system to document the case outcome
• Assist the scheduling and admissions staff with inquiries regarding medical necessity and authorizations
• Collaborate with necessary departments/providers to ensure overall accuracy of authorizations
• Complete post procedure reviews to initiate updates to existing authorizations
• May be assigned specific insurance plans and provider specialties but expected to learn on the job other insurances and specialties.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED