Patient Access Preauthorization/Precertification Specialist I - Radiology

MedStar Health; Maryland; On-site; USD 26,000 - 45,000; Full time

Job summary

MedStar Health is seeking a Preauthorization/Precertification Specialist to verify eligibility, obtain pre-authorizations, and ensure accurate data entry for billing prior to services.

The role focuses on radiology-related authorizations, communicating with payers and providers, and maintaining up-to-date knowledge of regulatory changes affecting pre-certification processes. Strong typing and system proficiency are essential.

Qualifications

• Requires working knowledge of payer authorization and clearance processes.
• Familiarity with UB04 HCFA 1500 or equivalent.
• Knowledge of CPT/ICD-10 coding.
• Excellent communication and organizational skills.
• Proficient in hospital registration and billing systems; MS Excel and Word.

Responsibilities

• Verify eligibility and pre-certification requirements for procedures.
• Obtain and enter pre-authorizations into the system and link to appointments.
• Communicate with payers, providers, and patients about authorizations.
• Enter data accurately in IDX, SMS/Invision, and other systems for billing.
• Monitor work queues and follow up to complete authorization requirements.

Skills

Payer authorization

Medical terminology

CPT/ICD-10 coding

Excel

Word

Billing systems

Typing 35 WPM

Education

High School Diploma

GED

Job description

About The Job

MedStar Health is looking for a Preauthorization/Precertification Specialist with strong experience and knowledge in

MedStar Health is looking for a Preauthorization/Precertification Specialist with strong experience and knowledge in radiology insurance authorization and insurance verification processes. The selected candidate will provide assistance to patients and providers by confirming and completing required pre-certification/authorizations prior to service to ensure a positive patient/provider experience and mitigate denials.

Primary Duties And Responsibilities

• Pre-Authorizations/Pre-Certification: Verifies eligibility and conformance to the department and departmental managed care requirements and contracts. References the MedStar Managed Care Matrix and online Handbook as necessary. Obtains insurance referrals and pre-authorizations. Submits all referral information to necessary providers as appropriate; Assists with pre-authorizations of scheduled procedures including hospital admissions procedures medications and medical equipment as required.
• Reviews all scheduled procedures and initiates authorization and pre-certification activities. Reviews all provider schedules confirms correct insurance information is available. Cross-references as needed to any application where documentation is stored to ensure completeness of work.
• Maintains ongoing communication with insurance companies to determine eligibility of benefits deductible status and to obtain precertification for assigned scheduled procedures. Responds to provider/hospital staff and/or patient inquiries regarding authorizations and scheduling in an efficient manner.
• Pre-Authorization/Pre-Certification: Ensures all relevant data is entered into the IDX application links data to the appropriate appointment/visit and enters the required data elements to ensure that accurate billing information is submitted to the appropriate insurance carrier. Obtains any missing pre-certification or authorization numbers and enters into the appropriate field in the Appointment Data Form (ADF) or other required fields as necessary. Communicates if the appointment needs to be rescheduled due to a missing Referral or Authorization number.
• Pre-Authorization/Pre-Certification: Confirms all relevant data is entered into SMS/Invision authorization fields to ensure accurate billing information is submitted to the appropriate insurance carrier. Obtains any missing pre-certification or authorization numbers and enters into the appropriate fields.
• Monitors and completes the MedConnect Pre-Authorization Work Queue as required with accurate authorization status and communicates with designated provider staff regarding any information required to complete the authorization requirements. This includes but is not limited to additional documentation Peer-to-Peer requests etc.
• Maintains current knowledge of regulatory and specific changes as it relates to Pre-Authorization and Pre-Certification requirements.
• Maintains daily performance benchmarks as it applies to interpreting and evaluating Pre-Authorization and Pre-Certification requirement to include follow up with payers and assigned providers
• Maintains departmental Quality Assurance standards within established error rate.

Minimal Qualifications

Education

• High School Diploma or GED required

Experience

• 1-2 years' experience in patient accounting, patient access or pre-arrival services functions required or an equivalent combination of experience and college education in accounting, finance or healthcare administration. required

Knowledge Skills And Abilities

• Working knowledge and demonstrated proficiency in payer authorization and clearance processes.
• Requires basic working knowledge of UB04 HCFA 1500 or equivalent and payer responses.
• Requires some knowledge of medical terminology and CPT/ICD-10 coding.
• Excellent communication analytical interpersonal and organizational skills.
• Proficient uses of hospital registration and/or billing systems and personal computers as well as Microsoft Excel and Word applications.
• Ability to type 35 WPM.

This position has a hiring range of

USD $18.70 - USD $32.72 /Hr.