Precertification Specialist - Scheduling (Monday-Friday 8:00am-4:30pm)

Pre-Certification Specialist

Washington Regional Medical Center is our region's only locally governed, community-owned, not-for-profit healthcare system. Our system includes a 425-bed acute care hospital located in the heart of Fayetteville supported by our clinic system - including primary, specialty and urgent care operations - that span across Northwest Arkansas into Harrison and Eureka Springs. Being heavily supported and invested in our community makes Washington Regional a unique employer, encouraging staff to give back to the community in which we live and work and give back to each other.

Washington Regional Mission, Vision and Values prove to be a firm foundation and inspiration from which we fulfill our purpose.

Mission: Washington Regional is committed to improving the health of people in communities we serve through compassionate, high quality care, prevention, and wellness education.

Vision: To be the leading healthcare system in Northwest Arkansas --- the best place to receive care and the best place to give care.

Values: To treat others - patients and their families, visitors, physicians, and each other - as we would want to be treated.

Position Summary

The role of the Pre-Certification Specialist reports to the Pre-Certification Specialist Lead and Scheduling Manager. This position will utilize the electronic medical record system to abstract pertinent information to prove medical necessity to the payor and to ensure precertification for services is obtained prior to the date of service.

Essential Position Responsibilities

• Effectively communicate with the ordering providers and/or necessary office staff for medical reviews/preauthorization regarding future cases
• Maintain a working knowledge of general payer and medical necessity requirements
• Review cases for possible denial and schedule peer reviews
• Utilize the appropriate system to document the case outcome
• Assist the scheduling and admissions staff with inquiries regarding medical necessity

Qualifications

• Education: High School Diploma or GED
• Licensure/Certifications: N/A
• Experience: Minimum of one year experience in a medical setting with a focus in coding, admitting, or precertification, preferred. Previous experience with CPT and ICD 10 codes, preferred.