Precertification Specialist (Full-time, 8:00am-4:30pm)

Washington Regional Medical System • Fayetteville, AR

5d • Onsite

About The Position

The Precertification Specialist uses the electronic medical record system to abstract information demonstrating medical necessity to payors and ensures that precertification for services is obtained before the date of service. The role researches resolutions to authorization issues and recommends process improvements to reduce authorization-related denials. The position reports to the Scheduling Manager and serves a culturally and linguistically diverse patient population.

Requirements

• High school diploma or GED.
• At least two years of experience in a medical setting, preferably focused on coding, admitting, or precertification.
• Experience with CPT and ICD-10 codes preferred.
• Ability to serve a culturally and linguistically diverse patient population.

Nice To Haves

• At least 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 clinic staff about medical reviews and preauthorization for future cases.
• Maintain current 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 questions about medical necessity and authorizations.
• Collaborate with relevant departments and providers to ensure authorization accuracy.
• Complete post-procedure reviews to initiate updates to existing authorizations.
• Learn additional insurance plans and provider specialties as needed, even if initially assigned specific plans and specialties.
• Research resolutions for authorization issues and recommend process improvements to reduce authorization-related denials.

What This Job Offers

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