Job Description Precertification Specialist

Job Description

Precertification Specialist

DESCRIPTION

The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully

completing the authorization process with all commercial payers.

RESPONSIBILITIES

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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

KNOWLEDGE, SKILLS, AND ABILITIES

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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, 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

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High School Diploma or GED

2 years medical prior authorization experience preferred

2 years experience in a medical related field required

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