Precertification Specialist

Bryn Mawr Medical Specialists Association•Bryn Mawr, PA

About The Position

The Pulmonary department at Bryn Mawr Medical Specialists Association is seeking a part-time Precertification Specialist to join its growing team. The specialist will handle all office-related precertifications. The ideal candidate has experience in precertifications, billing, and prior authorization, although candidates with less experience who are willing to learn are encouraged to apply. The potential base pay range is $18–$20 per hour. This is a good-faith estimate, not a guaranteed wage; actual compensation may vary based on the applicant’s knowledge, experience, education, skills, training, certifications, and qualifications, as well as market data, internal equity, and departmental budget. Final compensation and benefit eligibility may vary by role and employment status and will be confirmed at the time of offer. Benefits, PTO, and holiday pay are available only to employees working 24 hours or more per week.

Requirements

Precertification experience.
Prior authorization experience.
Insurance verification experience.
Experience working with multiple health insurance plans.
High school diploma or equivalent.

Responsibilities

Review chart documentation to ensure the patient meets medical policy guidelines.
Prioritize incoming authorization requests according to urgency.
Obtain authorization through payer websites or by phone and regularly follow up on pending cases.
Maintain individual payer files with up-to-date requirements for successfully obtaining authorizations.
Initiate appeals for denied authorizations.
Confirm the accuracy of CPT and ICD-10 codes.
Coordinate and confirm insurance coverage and payments for prescriptions, procedures, and other services.