Precertification Specialist-1

Medical University of South Carolina•Charleston, SC

About The Position

MUSC Community Physicians (MCP) is an entity within the Medical University of South Carolina (MUSC) that provides healthcare to patients within the rural health network throughout the state of South Carolina. This role is responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services. The Specialist determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care, via phone, fax, or payer websites. The Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. Other duties as assigned.

Requirements

High School Degree or Equivalent
1 year of work experience

Nice To Haves

Certification incentive program

Responsibilities

Verifying eligibility
Obtaining insurance benefits
Ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services
Determining which patient services have third party payer requirements
Obtaining the necessary authorizations for care, via phone, fax, or payer websites
Providing detailed and timely communication to both payers and clinical partners
Documenting the appropriate information in the patient's record