Pre-Certification Specialist Position Available In Charleston, South Carolina
Tallo's Job Summary: The Pre-Certification Specialist position at Chuck Dawley Blvd in Mount Pleasant, SC involves obtaining insurance approval for scheduled procedures. Responsibilities include reviewing documentation, prioritizing authorization requests, and communicating with patients and clinics. The role requires knowledge of medical policy guidelines, anatomy, and CPT/ICD-10 codes. Candidates should have prior authorization and medical field experience.
Job Description
Pre-Certification Specialist 3.3 3.3 out of 5 stars 1106 Chuck Dawley Blvd # 200, Mount Pleasant, SC 29464
Position:
Pre-Certification Specialist Department:
Finance Reports to:
Reimbursement Director FLSA Status:
Non-exempt Pay Type:
Hourly Position Type:
Full-time Effective Date:
January 31, 2024
Position Summary:
Responsible for working directly with insurance companies and obtaining approval for various procedures scheduled by SSI providers.
Working Conditions:
Sitting, standing, walking, bending, stooping, twisting, reaching overhead and lifting up to 40lbs. Primary duties include, but are not limited to: 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 Per-certify all Practice procedures Verify benefits for patients Work with Receptionist and Medical Assistants on schedule conflicts, benefits and deductibles, and surgery patients Report denials to Medical Assistants Calculate percentages for payments and report amounts to be collected
Position Requirements:
KNOWLEDGE, SKILLS, AND ABILITIES
Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle Understanding of payer medical policy guidelines 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
