Pre-Certification Specialist

Summary:

#The pre-certification specialist is responsible for obtaining prior authorizations for all procedural and ancillary orders by successfully completing the authorization process with all required payers.

Job Duties:

## Review chart documentation to ensure the patient meets medical necessity guidelines. Prioritize incoming authorization requests according to urgency. Obtain authorization via the payer website or by phone and follow up regularly on pending cases. Maintain current with payer requirements needed to successfully obtain authorizations. Initiate appeals for denied authorizations. Respond to clinic questions regarding payer medical necessity guidelines. Confirm accuracy of CPT and ICD-10 diagnoses in the procedure orders.

# Education/

Experience:

High School Diploma or General Education Degree (GED); 2 years prior medical authorization experience preferred; 2 years# experience in a medical-related field required, or equivalent combination of education and experience. Compensation # Benefits:#Competitive wages and excellent fringe benefit program.#Salary is based on#education and experience.# #

Summary:

The pre-certification specialist is responsible for obtaining prior authorizations for all procedural and ancillary orders by successfully completing the authorization process with all required payers.

Job Duties:

* Review chart documentation to ensure the patient meets medical necessity guidelines.

* Prioritize incoming authorization requests according to urgency.

* Obtain authorization via the payer website or by phone and follow up regularly on pending cases.

* Maintain current with payer requirements needed to successfully obtain authorizations.

* Initiate appeals for denied authorizations.

* Respond to clinic questions regarding payer medical necessity guidelines.

* Confirm accuracy of CPT and ICD-10 diagnoses in the procedure orders.

* Education/

Experience:

High School Diploma or General Education Degree (GED); 2 years prior medical authorization experience preferred; 2 years' experience in a medical-related field required, or equivalent combination of education and experience.

Compensation & Benefits:
Competitive wages and excellent fringe benefit program. Salary is based on education and experience.