Pre-Certification & Payer Authorization Specialist

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

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.