Precertification/Scheduling Specialist Position Available In Candler, Georgia
Tallo's Job Summary: The Precertification/Scheduling Specialist position in Metter, GA involves reviewing chart documentation, obtaining authorization, scheduling patient appointments, and maintaining payer files. Requirements include a high school diploma or GED, 2 years of medical prior authorization experience, and proficiency in CPT and ICD-10 codes. Strong organizational and customer service skills are essential. This fulltime permanent role requires the ability to handle multiple responsibilities, work independently, and maintain confidentiality. The role may involve sitting, standing, and lifting up to 25 pounds in a rapidly changing and stressful environment.
Job Description
Precertification/Scheduling Specialist
Job Type
Fulltime
Contract Type
Permanent
Location
Metter, GA
Job Description
ESSENTIAL FUNCTIONS
of this job description 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
Utilizes telephone courtesies on all telephone interactions
Obtains accurate and complete information for hospital consults and forwards to the appropriate Clinicians according to practice protocols
Accurately enters new & established patient information in the computer/scheduling program.
Obtains all insurance information for patient appointments according to practice protocols
Schedules patient appointments accurately according to individual provider’s scheduling template and follows practice protocols regarding approval for exceptions/add-ons
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 Maintains safe, secure, and healthy work environment by following, and enforcing standards and procedures; complying with legal regulations.
Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
Performs other tasks and duties as assigned in an efficient, effective and cost conscious manner, complying with all hospital policies, procedures, and regulations KNOWLEDGE, SKILLS, QUALIFICATION and
EDUCATIONAL AND /OR EXPERIENCE REQUIREMENTS
High School Diploma or GED
2 years medical prior authorization experience preferred
2 years experience in a medical related field required
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
Proficient use of CPT and ICD-10 codes
Proficiency in Microsoft Office Suite
Strong organizational and customer service skills
Ability to:
determine appropriate course of action in more complex situations
work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
manage multiple and simultaneous responsibilities and to prioritize scheduling of work
maintain confidentiality of all medical, financial, and legal information
complete work assignments accurately and in a timely manner
communicate effectively, both orally and in writing/electronically
handle difficult situations involving patients, physicians, or others in a professional manner
Possesses good interpersonal skills, initiative, integrity, flexibility, adaptability, and must be a team player
PHYSICAL DEMANDS / WORKING CONDITIONS
Sitting, standing, walking bending/twisting, kneeling/squatting, reaching, climbing and should be able to lift 25 or more pounds using proper lifting techniques. Rapidly changing and stressful environment. Ability to communicate with various levels of people. Possible exposure to communicable and infectious disease and hazardous materials. Occasional exposure to unpleasant patient or unit elements (accidents, injuries and illness). Contact with patients under a wide variety of circumstances. Subject to varying and unpredictable situations. Handles emergency or crisis situations. Subject to many interruptions. Occasional pressure due to multiple tasks and inquiries. The information in this job description is intended to describe the general nature and level of work being performed by people assigned to this classification and requirements for the performance of this job. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. Experience
Required/Preferred
