Pre-Certification Specialist

Upson Regional Medical Center; Thomaston (GA); On-site; USD 40,000 - 55,000; Full time

Job summary

Upson Regional Medical Center in Thomaston, Georgia, is seeking a Pre-Certification Specialist to review medical necessity and obtain pre-authorization before scheduling procedures. The role involves entering clinical data, applying CPT/ICD-10 codes, and coordinating with medical staff.

Qualified candidates will have a high school diploma and experience in a medical setting with health insurance verification. ICD-10 and CPT coding knowledge is preferred to ensure compliance and timely approvals.

Qualifications

• High school diploma or equivalent is required.
• Experience in a medical environment with health insurance verification.
• Familiarity with ICD-10 and CPT codes preferred.
• Ability to obtain prior authorizations and coordinate with care teams.

Responsibilities

• Review medical necessity and obtain authorization prior to scheduling.
• Enter necessary clinical data and CPT/ICD-10 codes.
• Coordinate with pre-certified staff and physician staff to obtain authorizations.
• Maintain knowledge of payer requirements to perform responsibilities.
• Demonstrate professional communication and attention to detail.

Skills

Medical environment experience

Health insurance verification

CPT/ICD-10 coding knowledge

Attention to detail

Education

High school diploma or equivalent

Job description

Pre-Certification Specialist

Upson Regional Medical Center Thomaston, Georgia, United States

About this position

Pre-Certification Specialist

Join a winning team!

Upson Regional Medical Center is a small hospital with a BIG heart! Our employees enjoy an environment where they can take care of patients with a high degree of quality and compassion. Patients get to experience top-notch healthcare with modern technology and a team with a focus of excellence for every patient, every time.

The Pre-Certification Specialist conducts a review for medical necessity in a timely and thorough manner & enters necessary clinical data and CPT/ICD-10 codes to obtain authorization for services prior to scheduling. Utilizes critical thinking and problem-solving skills to coordinate with pre-certified staff and physician staff to obtain authorizations. Maintains clinical competency and current knowledge of payer requirements to perform pre-certification responsibilities. Demonstrates a high degree of professional skill in personal interactions both in oral and written communications, as well as being detail oriented.

Requirements: High school diploma or equivalent. Must have experience in a medical environment with health insurance verification. Prefer experience and knowledge of ICD-10 and CPT codes.