Precertification Specialist Full Time

Position Goal

Complete the precertification and prior authorization process by calling insurance companies, adjusters, and patients. Communicate the approval or denial of surgeries and/or tests effectively to physicians, physicians’ staff, and patients. Complete accuracy checks between AccuReg reports and registration information in Medhost.

Position Responsibilities:

• Responsible for obtaining precertification and prior authorization for patients scheduled for a surgical procedure and/or tests as ordered by physician
• Responsible for obtaining all necessary information required to obtain precertification or prior authorization to include clinical dictation and test results
• Provide accurate information to insurance companies based on test results, clinical dictation, etc.
• Verify/re-verify insurance benefits and eligibility for each scheduled surgical procedure and/or test
• Complete precertification and prior authorization process in a timely, efficient manner with respect to urgent requests.
• Performs quality checks for scanned AccuReg insurance verification against the information updated during the registration process.
• Other duties as assigned

Experience:  One year of medical insurance and medical terminology experience required. Basic computer skills required.

Education: High school diploma or equivalent required

Special Qualifications:

Required:

• One year of medical insurance and medical terminology experience required. Basic computer skills required.

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.