Pre-Certification & Scheduling Specialist - Urology

Charleston Area Medical Center; Hurricane (WV); On-site; USD 36,000 - 54,000; Full time

Job summary

Charleston Area Medical Center (CAMC) Urology – Teays Valley is seeking a Pre-Certification Specialist to ensure accurate pre-certification authorizations and referrals for returning and new patients, and to schedule physician-ordered tests and surgeries at Teays Valley (US WV Hurricane).

This on-site role requires handling patient charts, coordinating with insurers, and maintaining up-to-date medical terminology and coding knowledge including ICD-10, CPT, and HCPCS.

Qualifications

• High School Diploma or GED is required.

Responsibilities

• Daily review of charts to determine if pre-certification/pre-authorization or referrals are needed.
• Review specific patient insurance info to determine medical necessity requirements for specific treatments.
• Correspond with medicare and various insurance companies to facilitate obtaining pertinent data on compliance, authorizations, verifications, progress notes, medical necessity guidelines and precertification and pre-authorization requirements.
• Perform clerical duties as necessary, including composing letters to patients, insurance carriers and referring physicians regarding any issues.
• Per physician order, schedule patient surgery and communicate all necessary information to the appropriate parties.
• Make subsequent referrals to other physicians per physician review of test/scan results.
• Establish new patient account in billing software upon receiving referral from physician. Forward all applicable info to appropriate personnel for inclusion in the medical chart.
• Maintain continuing education treatment trends, current medical terminology used in pre-certification, and ICD-10, CPT and HCPCS codes.
• Cross train for front desk and medical assistant roles. Provide back up as needed.
• Schedule all procedures, collect, apply and deposit all funds.

Education

High School Diploma or GED

Job description

Charleston Area Medical Center (CAMC) Urology – Teays Valley is seeking a Pre-Certification Specialist to ensure accurate pre-certification authorizations and referrals for returning and new patients, and to schedule physician-ordered tests and surgeries at Teays Valley (US WV Hurricane).

This on-site role requires handling patient charts, coordinating with insurers, and maintaining up-to-date medical terminology and coding knowledge including ICD-10, CPT, and HCPCS.