Percertification/Authorization Specialist - Palmetto Park Blvd.

MUSC Health; Lexington (SC); On-site; USD 36,000 - 60,000; Full time

Job summary

MUSC Health in Lexington, SC seeks an Eligibility Specialist to verify patient eligibility, obtain insurance benefits, and secure pre-certifications and referrals for inpatient, outpatient, and ancillary services. You will coordinate with payers and clinical partners to ensure payer requirements are met and maintain accurate documentation in patient records.

As part of MUSC Community Physicians (MCP), this hourly role emphasizes timely communication with payers and internal colleagues to support

Qualifications

• Verifies insurance eligibility and benefits.
• Coordinates pre-certification, authorizations, and referrals with payers.
• Documents required information in patient records.
• Communicates with payers and clinical partners to ensure payer requirements are met.

Responsibilities

• Verify eligibility for services prior to care.
• Obtain necessary authorizations and referrals from payers.
• Inform payers and clinical teams about requirements and status.
• Document all relevant information in the patient record.

Skills

Eligibility verification

Insurance benefits

Pre-certification

Authorization

Referral management

Payer communication

Documentation

Education

High School Degree or Equivalent

Job description

Job Description Summary

Job Description

Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care, via phone, fax, or payer websites. The Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. Other duties as assigned.

Entity

MUSC Community Physicians (MCP)

Worker Type

Employee

Worker Sub-Type

Regular

Cost Center

CC001878 MCP - Columbia Heart Lexington

Pay Rate Type

Hourly

Pay Grade

Health-20

Scheduled Weekly Hours

40

Job Description

Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care, via phone, fax, or payer websites. The Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. Other duties as assigned.

Additional Job Description

Education: High School Degree or Equivalent Work Experience: 1 year

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees