Job Description
The surgical precertification specialist team is responsible for obtaining prior authorizations for approximately 1000 surgical procedures per month.
- The Pre-Auth Specialist will identify eligibility and authorization issues.
- Provide clinical documentation to assure timely authorization.
- Processing of daily paperwork for dictation.
- Prioritize incoming surgical authorization requests
- Obtain authorizations via payer websites, by phone or FAX and regular follow up on pending cases
- Maintain individual payer files to include current, up to date requirements needed to successfully obtain authorizations
- Initiate appeals for upfront denied authorizations and follow through until completion-even if end result is still a denial
- Demonstrate professional communication skills with providers, clinical staff and outside stakeholders.
- Confirm accuracy of CPT and ICD-10 coding
- Contact patients to discuss authorization status
Skills, Minimum Qualifications
- High school diploma or GED
- Professional certifications preferred
- 2 years prior experience obtaining surgical authorizations required
- 2 years prior experience in a medical related field required
- Ability to multi-task and remain focused while managing a high volume, time-sensitive workload
- Demonstrate excellent communication and customer service skills
- Expected to be detailed oriented with above average organizational skills
- Expected to have an understanding of payer medical policies and guidelines and use these guidelines to manage authorizations effectively
- Familiarity with both governmental and commercials insurance plans
- Expected to have knowledge of medical terminology related to multispecialty surgical procedures
- Expected to have excellent computer skills including Excel, Word and Internet use
Job Type: Full-time
Pay: From $20.00 per hour
Benefits:
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Weekly day range:
Application Question(s):
- Ability to recognize all commercial and governmental payers.
Education:
- High school or equivalent (Required)
Experience:
- Surgery Authorization: 2 years (Required)
- medical field: 2 years (Required)
Language:
License/Certification:
Work Location: In person