Pre-Certification & Scheduling Specialist (Healthcare)

Charleston Area Medical Center; Charleston (WV); On-site; USD 32,000 - 45,000; Full time

Job summary

Charleston Area Medical Center in Charleston, WV seeks a Pre-Certification Specialist to ensure accurate pre-certification authorization/referral and to review patient charts. Duties include scheduling physician-ordered tests and surgeries, communicating with insurers, and maintaining billing information.

Responsibilities cover chart reviews, medical necessity determinations, data collection for authorizations, and clerical tasks.

Qualifications

• High school diploma or GED required.
• Experience with pre-certification and scheduling processes is a plus.
• Familiarity with ICD-10, CPT, and HCPCS codes is helpful.

Responsibilities

• Daily review of charts to determine pre-certification or referrals needed.
• Review patient insurance information to determine medical necessity requirements for treatments.
• Correspond with Medicare and various insurers to obtain data on authorizations, verifications, and guidelines.
• Perform clerical duties including composing letters to patients, carriers, and physicians.
• Schedule patient surgery and communicate information to relevant parties.
• Establish new patient accounts in billing software and forward information for chart inclusion.
• Maintain knowledge of medical terminology and coding used in pre-certification.
• Cross-train for front desk and medical assistant roles and provide backup as needed.
• Schedule all procedures and manage funds collection and deposits.

Education

High School Diploma or GED

Job description

Charleston Area Medical Center in Charleston, WV seeks a Pre-Certification Specialist to ensure accurate pre-certification authorization/referral and to review patient charts. Duties include scheduling physician-ordered tests and surgeries, communicating with insurers, and maintaining billing information.

Responsibilities cover chart reviews, medical necessity determinations, data collection for authorizations, and clerical tasks.