The Precertification Specialist will be responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers. Two years of experience in a medical related field required, along with a high school diploma or GED. Two years medical prior authorization experience preferred.
The Precertification Specialist will have the following 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
This a full-time, in-person position with a Monday to Friday schedule.
Our Full-Time Employee Benefits Include:
- Health/Dental/Vision Insurance
- Paid time off (PTO)
- Holiday PTO
- 401(k) plan
- Profit sharing plan
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