Precertification Specialist (Full-time, 8:00am-4:30pm)
About The Position
The Precertification Specialist reports to the Scheduling Manager and uses the electronic medical record system to abstract information supporting medical necessity to payors and ensure that precertification for services is obtained before the date of service. The role researches resolutions for authorization issues and recommends process improvements to reduce authorization-related denials. The position may be assigned specific insurance plans and provider specialties, with an expectation to learn other plans and specialties on the job. The role serves a culturally and linguistically diverse patient population.
Requirements
- High school diploma or GED.
- Minimum of two years of experience in a medical setting focused on coding, admitting, or precertification is preferred.
- Previous experience with CPT and ICD-10 codes is preferred.
Nice To Haves
- Minimum of two years of experience in a medical setting focused on coding, admitting, or precertification.
- Previous experience with CPT and ICD-10 codes.
Responsibilities
- Communicate with ordering providers and/or clinic staff about medical reviews and preauthorization for future cases.
- Maintain current working knowledge of authorization and medical necessity requirements.
- Review cases for anticipated denials and schedule peer reviews.
- Document case outcomes in the appropriate system.
- Assist scheduling and admissions staff with medical necessity and authorization inquiries.
- Collaborate with relevant departments and providers to ensure authorization accuracy.
- Complete post-procedure reviews to initiate updates to existing authorizations.
- Research authorization issue resolutions and recommend process improvements to reduce authorization-related denials.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
