Position: Pre-Certification Specialist

Summary: Responsible for working directly with insurance companies and obtaining approval for various procedures scheduled by SSI providers.

Working Conditions: Sitting, standing, walking, bending, stooping, twisting, reaching overhead and lifting up to 40lbs.

Primary duties include, but are not limited to:

• Review chart documentation to ensure patient meets medical policy guidelines
• Prioritize incoming authorization requests according to urgency
• Obtain authorization via payer website or by phone and follow up regularly on pending cases
• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
• Initiate appeals for denied authorizations
• Respond to clinic questions regarding payer medical policy guidelines
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Contact patients to discuss authorization status
• Other duties as assigned
• Per-certify all Practice procedures
• Verify benefits for patients
• Work with Receptionist and Medical Assistants on schedule conflicts, benefits and deductibles, and surgery patients
• Report denials to Medical Assistants
• Calculate percentages for payments and report amounts to be collected

Position Requirements:

KNOWLEDGE, SKILLS, AND ABILITIES• Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle• Understanding of payer medical policy guidelines• Basic understanding of human anatomy, specifically musculoskeletal• Proficient use of CPT and ICD-10 codes• Excellent computer skills including Excel, Word, 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 multitask and remain focused while managing a high-volume, time-sensitive workload EDUCATION/EXPERIENCE REQUIRED • High School Diploma or GED• 2 years medical prior authorization experience preferred• 2 years experience in a medical related field required

Job Type: Full-time

Pay: $19.00 - $25.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Retirement plan
• Vision insurance

Weekly day range:

• Monday to Friday

Experience:

• Insurance verification: 2 years (Preferred)
• Medical billing: 2 years (Required)

Ability to Commute:

• Mount Pleasant, SC 29464 (Required)

Ability to Relocate:

• Mount Pleasant, SC 29464: Relocate before starting work (Required)

Work Location: In person