Medical Precertification Specialist Position Available In Bibb, Georgia

Medical Precertification Specialist Middle Georgia Heart & Vascular Macon, GA Job Details Full-time From $16 an hour 2 days ago Benefits Health insurance Dental insurance 401(k) Paid time off Vision insurance Life insurance Qualifications Microsoft Word Microsoft Excel Microsoft Access Microsoft Outlook EHR systems ICD coding Customer service Word processing Mid-level Windows Microsoft Office eClinicalWorks High school diploma or

GED ICD-10

Health insurance Translating medical terminology CPT coding EMR systems Typing Communication skills Time management Full Job Description Job Overview The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all payers. Adheres to the values and Goals of the organization. Understands our Mission and Vision.

Essential Duties:

• Utilize ICD-10 and CPT codes to ensure proper authorization for procedure.
• Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details.
• Knowledgeable of CMS Guidelines and LCD (Local Coverage Determination) / NCD (National Coverage Determination) for Procedures.
• Notifies supervisor of known or potential issues.
• Responsible for Documenting all precertification activities in the Electronica Health Record (HER)
• Maintain Accurate Logs for Compliance and Billing.
• Communicate with the Providers and Clinical Staff to Clarify Orders and Diagnosis.
• Notify Patients of authorization Denial Statuses.
• Independently works from the Insurance Web portals and other electronic resources.
• Provides detailed, accurate and current clinical information to insurance representatives.
• Follow up on Pended/Denied/Appeal requests for authorization.
• Maintain a strong working knowledge of precertification and referral requirements by insurance carrier.
• Verify receipt of all necessary pre-authorization documents prior to treatment.
• Schedules PEER to PEERs for the Providers.
• Overtime may be necessary, but approval is required.
• Perform any other assigned duties as directed by the immediate supervisor.

Qualifications:

• Work experience in the health care sector that exposes the candidate to medical terminologies, diagnostic procedures, and health care billing and authorization
• Strong communication and customer service skills
• The ability to learn quickly and work under pressure in a fast-paced environment
• Proficiency in word processing and spreadsheet applications
• Minimum typing speed of 50 words per minute
• Attention to details
• Excellent organizational and time management skills
• Good working ethics and ability to treat documents with confidentiality
• The ability to work effectively as part of a team and take initiatives when the need arises.

Highschool Diploma or GED Key Competencies:

Pre-certification specialists play a critical role in managing patient care, costs of treatment and medication and revenue cycle management. They must have an in-depth understanding of various insurance policies and billing procedures to streamline authorization processes and provide patients with prompt access to medication and treatment. His/her job description includes managing the prospective client or patient’s medical records, inputting and updating patient’s insurance information.

Work Environment:

Medical Office Setting / Centralized Business Office Dress code:

Uniforms or Business Casual Neat, Clean, and Organized Work Area Job Type:

Full-time Pay:

From $16.00 per hour

Benefits:

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

Schedule:

8 hour shift Monday to

Friday Work Location:

In person