Precertification Specialist

DESCRIPTION

The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers. We are seeking a highly organized and detail oriented Specialist to join a very busy ENT Practice along the MS Gulf Coast. The ideal candidate will have knowledge of medical terminology, coding, insurance verification and experience working in a dental or medical office.

RESPONSIBILITIES

• Review chart documentation to ensure patient meets medical policy guidelines

• Prioritize incoming authorization requests according to urgency

• Obtain authorization via payer website or by phone and follow up regularly on pending cases

• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations • Initiate appeals for denied authorizations

• Respond to clinic questions regarding payer medical policy guidelines

• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order

• Contact patients to discuss authorization status

• Other duties as assigned

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle

• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively

• Basic understanding of human anatomy, specifically musculoskeletal

• Proficient use of CPT and ICD-10 codes

• Excellent computer skills including Excel, Word, and Internet use

• Detail oriented with above average organizational skills

• Plans and prioritizes to meet deadlines

• Excellent customer service skills; communicates clearly and effectively

• Ability to multitask and remain focused while managing a high-volume, time-sensitive workload

EDUCATION/EXPERIENCE REQUIRED

• High School Diploma or GED

• 2 years medical prior authorization experience preferred

• 2 years experience in a medical related field required

Job Type: Full-time

Pay: $17.50 - $19.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Weekly day range:

• Monday to Friday

Ability to Relocate:

• Biloxi, MS: Relocate before starting work (Required)

Work Location: In person