Pre-Certification & Authorization Specialist

Southwest Spine And Pain Care Specialists Llc; St. George (VT); Presencial; USD 42.000 - 64.000; Jornada completa

Descripción de la vacante

Southwest Spine And Pain Care Specialists Llc is seeking a healthcare coordinator to manage prior authorization workflows. You will answer calls, collect and enter data, review clinical information for approvals, and coordinate with physicians and insurers to secure scheduling and coverage.

The role emphasizes customer service, accuracy, and timely processing. Ideal candidates have at least six months of prior authorization experience, familiarity with CPT/ICD-10, and strong communication skills

Formación

• Six months of prior authorization experience or training supplied.
• Knowledge of CPT and ICD-10 coding.
• Familiarity with medical terminology.
• High School education or GED.
• Ability to interact with patients, insurers and office staff professionally.

Responsabilidades

• Answer calls from patients and physician offices with exemplary customer service.
• Enter required information into the computer system accurately.
• Review clinical data against medical criteria for authorization review.
• Check orders for insurance coverage and pre-certification needs.
• Obtain missing documentation from physicians or offices.
• Coordinate with insurers to pre-certify/authorize procedures as ordered.
• Communicate updates to ordering physicians if denied and assist with peer-to-peer reviews as needed.
• Monitor pre-cert status to ensure timely processing and completion.
• Log orders and schedule procedures upon approval.

Conocimientos

CPT/ICD-10 codes

Medical terminology

Accurate data entry

Communication with patients/insurers

EMR/database entry

Teamwork

Prior authorization experience

Educación

High School Diploma or GED

Descripción del empleo

Southwest Spine And Pain Care Specialists Llc is seeking a healthcare coordinator to manage prior authorization workflows. You will answer calls, collect and enter data, review clinical information for approvals, and coordinate with physicians and insurers to secure scheduling and coverage.

The role emphasizes customer service, accuracy, and timely processing. Ideal candidates have at least six months of prior authorization experience, familiarity with CPT/ICD-10, and strong communication skills