Precertification Specialist

DESCRIPTION

The Precertification Specialist is responsible for obtaining prior authorizations for all treatment by successfully completing the authorization process with all commercial, automobile and workers compensation payers.

RESPONSIBILITIES

• Review chart documentation to ensure patient meets medical policy guidelines
• Prioritize incoming authorization requests according to urgency
• Obtain authorization via payer website, fax or by phone and follow up regularly on pending submission
• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
• Initiate appeals for denied or modified authorizations
• Respond to clinic questions regarding payer medical policy guidelines
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Other duties as assigned

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of treatment authorization and its direct impact on the practice's revenue cycle
• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
• Proficient use of CPT and ICD-10 codes
• Excellent computer skills including Adobe, Excel 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 efficiently manage and prioritize time-sensitive tasks that arise

EDUCATION/EXPERIENCE REQUIRED

• High School Diploma or GED
• 2 years medical prior authorization experience preferred
• 2 years experience with conservative specialties (Chiropractic, Physical Therapy or Occupational Therapy) preferred.

Benefits:

• Collaborative environment fostering continued growth in a multidisciplinary approach
• VERY competitive salary and a runway for professional growth
• Medical, Dental, and Vision Insurance
• Accrued paid time off, sick time, and six paid company holidays
• Annual CEU reimbursement budget for licensed clinicians
• Retirement savings account with a percentage based company match

Work Location:

• Hybrid

Schedule:

• Monday to Friday

COVID-19 considerations: Alliance Orthopedics is educating employees and patients about steps they can take to protect themselves and others through the implementation of the CDC recommendations. We are also implementing additional measures to keep our facilities clean.