Precertification Prior Authorization Specialist, Centralized

PRECERTIFICATION PRIOR AUTHORIZATION SPECIALIST, CENTRALIZED

Location:

SGMC Patient Financial Services

Department: CENTRAL SCHEDULING

Schedule:

Full Time, 8 HR Day Shift

Responsible for obtaining precertification and/or prior authorization for each patient for which testing or procedures have been ordered by PCCC Medical Oncologists and Radiation Oncologists, including but not limited to all radiologic testing, injections, chemotherapy and/or radiation treatments, prior to services being rendered. The precertification and/or authorization must be obtained on each patient by 2:00 p.m. on the day prior to their scheduled appointment.

If not able to obtain precertification and/or authorization, the specialist must contact the patient to reschedule their appointment. Responsible for reviewing the accuracy of information requested and received regarding precertification and/or prior authorization numbers, as well as supporting documents. Responsible for uploading into both Mosaiq and HIS (Series) software the authorization numbers, time spans/number of procedures, and supporting documentation after verification that procedures are authorized as requested.

Responsible for appropriate use of the Quality Check List (QCL) in Mosaiq as a notification system for monitoring authorization requests and expiring authorizations. Responsible for documentation in Mosaiq as the official medical record, following appropriate guidelines. Contribute to program development and perform other duties as identified and assigned by the manager.

• Obtain precertification and prior authorization for patient procedures.

• Verify accuracy of authorization information and supporting documentation.

• Upload and document authorization data in Mosaiq and HIS.

• Use QCL in Mosaiq for monitoring and notify when authorizations expire.

• Maintain proper documentation and comply with medical record guidelines.

• Participate in program development and perform additional duties as assigned.

• High school graduate preferred.
• Minimum one year of administrative experience or equivalent; preferably in a hospital or medical office setting with working knowledge of insurance and managed care.
• Excellent computer skills – PC and Windows literacy required, and proficiency with Microsoft Office applications (Outlook, Word, Excel, etc.) and various office machines.
• Prior use of medical office software database preferred.
• Excellent communication and interpersonal skills, capable of working effectively as part of a team and responding well to supervision.
• Self‑motivated and proactive in tackling important issues, problems, and tasks.
• Strong attention to detail, with the ability to manage multiple tasks, meet deadlines, and remain flexible to adapt to varying job demands; capable of cross‑training to other functions as needed.
• Requires flexibility in work schedule to meet accountability expectations for operations and process management in a customer‑focused environment.

Generally a regular work schedule during normal office hours. Work is conducted comfortably indoors. The role may involve high levels of stress and requires the ability to sit for prolonged periods. Moderate heavy lifting (0–25 lbs.), reaching, stooping, pushing, pulling, bending, and twisting may be required. Must be able to operate office equipment including fax machine, copier, and computer.

• Low healthcare insurance premiums
• 401(k) with employer match
• Paid Time Off (PTO)
• Employee discounts
• Company‑paid life insurance
• Short‑Term and Long‑Term Disability
• Cancer Insurance
• Accident Insurance
• Pet Insurance
• Tuition Reimbursement
• On‑the‑job training and skills development
• Opportunities for growth and advancement
• Employee Assistance Program

At SGMC Health we are collectively working towards goals that will make our community a better place. We strive to do the right thing the right way, are accountable in all we do, require competence from our people, and are compassionate in our service. We encourage team effort, support personal and professional development, acknowledge individual talents and skills, and support innovation and empowerment.

We are committed to providing the best care possible and are proud to be recognized locally, statewide, and nationally for the exceptional care that our staff provides.