Medical Precertification & Verification

Job Description

Job Description

JOB SUMMARY

Precertification and verification specialist verifies and obtains authorizations for all procedural orders and tasks in an efficient and timely manner while maintaining a high level of customer service.

• Prioritize incoming authorization requests. Obtaining authorization via payer website or by phone and follow up regularly on pending cases
• Initiate appeals for denied authorizations.
• Respond to clinic questions regarding payer medical policy guidelines.
• Confirm accurate CPT and ICD-10 are medically necessary for procedure.
• Effectively verify insurances and inputs insurance benefits and authorizations in the proper context and location.
• Maintains/updates current insurance authorization requirements and policies. Notify department of changes and updates as needed.
• Receives internal and external telephone calls to answer questions and resolve problems regarding insurance benefits, verifications, and/or authorizations in a concise and courteous manner.
• Maintains patient confidentiality and complies with HIPAA guidelines.
• Perform related work as required.

• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations

• Proficient use of CPT and ICD-10 code.
• 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.

• High School Diploma or GED
• 2 year’s medical prior authorization experience preferred
• 2 years’ experience in a medical related field required

Work Location:

In person