Authorization Specialist | FT | Weekdays | Neurology Clinic | Memphis

Methodist Le Bonheur Healthcare; Memphis (TN); Presencial; USD 42 000 - 64 000; Tempo integral

Resumo da oferta

Methodist Le Bonheur Healthcare in Memphis seeks a precertification specialist to review and authorize medical services for inpatient, diagnostic, and outpatient procedures. You will ensure complete documentation adheres to insurer guidelines and supports medical necessity and payment.

Responsibilities include coordinating all necessary precertification documentation and building strong relationships with physicians, staff, patients, and the care team.

Qualificações

• High School Diploma or Equivalent required.
• Medical insurance authorizations and/or clinical experience 1-3 years.
• Knowledge of CPT, HCPCS, and ICD-10 codes preferred.
• Strong attention to detail and analytical thinking are essential.
• Excellent verbal and written communication skills.

Responsabilidades

• Precertification of eligible medical services and procedures for inpatient, diagnostic, and outpatient services.
• Coordinates all documentation required for precertification of services.
• Establishes a good working relationship with physicians, office staff, patients, and healthcare team.

Conhecimentos

Attention to detail

Analytical ability

Verbal communication

Written communication

Microsoft Word

PPO knowledge

Managed Care

Medical authorizations

Formação académica

High School Diploma or Equivalent

Licensed Practical Nurse (LPN) Tennessee

Ferramentas

Microsoft Word

Descrição da oferta de emprego

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!

We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South.

Responsible for precertification of eligible medical services and procedures for inpatient, diagnostic, and outpatient services. Ensures complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

A Brief Overview

Responsible for precertification of eligible medical services and procedures for inpatient, diagnostic, and outpatient services. Ensures complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What you will do

• Responsible for precertification of eligible medical services and procedures for inpatient, diagnostic, and outpatient services based on medical plan documents and medical necessity. Manages pre-certifications for more complex surgical and invasive procedures that require strong clinical knowledge.
• Coordinates all documentation required for precertification of services.
• Establishes a good working relationship with physicians, physician office staff, patients, and other members of the healthcare team.

Education/Formal Training Requirements

• Required - High School Diploma or Equivalent

Work Experience Requirements

• Required - Medical insurance authorizations and/or clinical experience 1-3 years

Licenses and Certifications Requirements

• Preferred - Licensed Practical Nurse - Tennessee - Tennessee Board of Nursing

Knowledge, Skills and Abilities

• Knowledge and experience in coverage practices, terminology, and requirements for referrals and authorization/pre-certification used by third party payers, Medicare, and secondary payer rules.
• Knowledge of CPT, HCPCS, and ICD-10 codes preferred.
• Demonstrated analytical ability to collect and interpret insurance and contract information.
• Experience dealing with PPO and Managed Care insurance.
• Strong attention to detail and critical thinking skills.
• Experience with a computerized healthcare information system required. Familiarity with fundamental Microsoft Word software.
• Excellent verbal and written communication skills.

Supervision Provided by this Position

• There are no lead or supervisory responsibilities assigned to this position.

Physical Demands

• The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
• Must have good balance and coordination.
• The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
• The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
• The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative.

Our Associates are passionate about what they do, the service they provide and the patients they serve. We value family, team and a Power of One culture that requires commitment to the highest standards of care and unity.

Boasting one of the South's largest medical centers, Memphis blends a friendly community, a thriving and growing downtown, and a low cost of living. We see each day as a new opportunity to make a difference in the lives of the people in our community.