Diagnostic Precert Specialist

Precertification Specialist Job Description Full-time precertification specialist needed for multidisciplinary medical practice. Medical Office Personnel with administrative responsibilities focuses on obtaining pre-certifications and authorizations for diagnostic procedures for our orthopedic, neurosurgical, and pain management physicians. The candidate must be detail-oriented, focused, organized, and a team player with an attitude to contribute meaningfully to the practice.

Responsibilities :

Contacts insurance companies and other third-party payers to determine preauthorization requirements for diagnostic services. Calls insurance companies or uses online tools to obtain preauthorization. Follows up timely and thoroughly. Ensures all preauthorization issues are communicated in a timely manner. Liaisons with the physician's staff to obtain additional insurance and/or clinical information. Reviews patients' charts and submits appropriate and pertinent information from the clinicals for medical necessity for the service. Follows up properly on all denials and peer-to-peer requests. Documents appropriately regarding all actions, authorization, and denials.

Qualifications:

Able to prioritize, work accurately, work well independently and able to maintain focus under pressure Working knowledge of medical terminology, insurance packages/plans and proficient with EMR Clearly communicate with providers, insurance companies and staff. Excellent verbal and written communication skills Excellent organizational skills, multi-tasking capabilities and detail orientated Customer Services skills Basic Computer/PC and Internet skills Attention to details and problem-solving skills Must be a great team player High School Diploma (Required) 1 year precertification experience (preferred) Monday - Friday 8am - 5pm