Precertification Specialist

Job Details Job Location: Caldwell Medical Center - PRINCETON, KY 42445 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 MINIMUM EDUCATION High School Diploma or GED PREFERRED EDUCATION Knowledge of medical terminology Familiarity with different insurance types MINIMUM EXPERIENCE 1 year experience in a medical related field required Previous experience in a clinic setting PREFERRED EDUCATION 1 Year pre-certification or pre-authorization experience preferred #J-18808-Ljbffr