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.
• 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.

Facility Pratt Regional Medical Center
Department Administration
Shift Days, Full Time