Pre-Certification Specialist

Diagnostic Testing Precertification Specialist

DESCRIPTION

The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully

completing the authorization process.

RESPONSIBILITIES

• Prioritize incoming authorization requests according to urgency

• Obtain authorization via payer website or by phone and follow up regularly on pending cases

• 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

• Other duties as assigned

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of procedure 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 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

• 1 year’s medical prior authorization experience preferred

• 1 years’ experience in a medical related field required