Precertification Specialist

Precertification Specialist

Caldwell Medical Center - PRINCETON, KY

POSITION SUMMARY:

• This position is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with our providers, transcribes and triages patient calls to physicians, coordinates patient appointments/orders.

KEY RESPONSIBILITIES

• Review chart documentation to ensure patient meets medical policy guidelines.
• Prioritize incoming authorization requests according to urgency.
• Obtain authorization via payer files to include up to date requirements needed to successfully to 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
• Contact insurance carriers to verify patient's insurance eligibility, benefits and requirements.
• Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
• Request and follow up and secure prior-authorizations prior to services being preformed
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations
• Communicate any insurance changes or trends among them
• Maintains a level of productivity suitable for the department
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
• Other duties as assigned

QUALIFICATIONS

• High School Diploma or GED
• Knowledge of medical terminology
• Familiarity with different insurance types
• 1 year experience in a medical related field required
• Previous experience in a clinic setting
• 1 Year pre-certification or pre-authorization experience preferred