What are the responsibilities and job description for the Pre-Certification Specialist position at Pratt Regional Medical Center?
Summary
Summary: The pre-certification specialist is responsible for obtaining prior authorizations for all procedural and ancillary orders by successfully completing the authorization process with all required payers.
Job Duties:
- Review chart documentation to ensure the patient meets medical necessity guidelines.
- Prioritize incoming authorization requests according to urgency.
- Obtain authorization via the payer website or by phone and follow up regularly on pending cases.
- Maintain current with payer requirements needed to successfully obtain authorizations.
- Initiate appeals for denied authorizations.
- Respond to clinic questions regarding payer medical necessity guidelines.
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure orders.
Education/Experience: High School Diploma or General Education Degree (GED); 2 years prior medical authorization experience preferred; 2 years’ experience in a medical-related field required, or equivalent combination of education and experience.
Compensation & Benefits: Competitive wages and excellent fringe benefit program. Salary is based on education and experience.