Percertification/Authorization Specialist - Palmetto Park Blvd.

Medical University of South Carolina; Woodsen (SC); On-site; USD 2,480,000 - 3,857,000; Full time

Job summary

MUSC Community Physicians (MCP) is seeking an Employee to verify eligibility, obtain insurance benefits, and secure pre-certifications and referrals before inpatient and outpatient services. The role requires detailing payer requirements and documenting information in patient records, with strong communication between payers and clinical partners.

Education includes a high school degree or equivalent with at least 1 year of related work experience.

Qualifications

• Experience verifying patient eligibility and insurance benefits.
• Knowledge of pre-certification, authorization, and referral requirements.

Responsibilities

• Verify eligibility and ensure payer requirements are met before services.
• Obtain authorizations via phone, fax, or payer websites.
• Communicate with payers and clinical partners to ensure compliance.
• Document necessary information in the patient’s record.

Skills

Eligibility verification

Insurance benefits

Pre-certification

payer communication

Documentation in patient records

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, http://www.uscis.gov/e-verify/employees