Precertification Specialist - Full Time

• Contact insurance company to verify patient coverage and obtain information concerning extent of benefits
• Completes forms as required by insurance to permit treatment by provider
• 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
• Properly utilize EMR system and remain up to date on required training and procedures related to EMR system
• Secure patient information and maintain patient confidentiality
• Assist in coverage of other staff when necessary; Participate in orientation of employees when needed
• Communicate efficiently with other departments to ensure best care for patient

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required

• High School diploma or equivalent required at minimum
• Experience working in related position preferred

• Requires prolonged periods of sitting at desk, working at computer, and being on the phone
• Must have good computer and telephone communication skills and able to operate misc. office equipment
• Hearing and vision abilities within normal range, or corrected, to observe and communicate with patients and staff
• Ability to work in fast-paced environment in a professional medical office setting
• Reasonable accommodations may be made to enable individuals with disabilities to perform the necessary functions

Full time: 40 hours minimum per week; available for overtime as needed; varied day shift hours on week days

No travel anticipated