Pre-Certification Specialist (Ambulatory)

Holzer Health System; Bidwell (OH); On-site; USD 42,000 - 54,000; Full time

Job summary

Holzer Health System in Bidwell, OH seeks a Pre-Certification Specialist (Ambulatory) to manage precertification of outpatient procedures within the Clinic.

You will communicate with third-party payers and Utilization Review to secure approvals, monitor radiology schedules, and coordinate with clinic departments to obtain precertification, all while making independent, well-reasoned decisions. This is a full-time day shift position reporting to the Precertification Department Manager.

Responsibilities

• Precertification outpatient procedures with third party payers and Utilization Review Departments.
• Ensure procedures are authorized and medically necessary.
• Communicate with Clinic departments to obtain precertification.
• Monitor Radiology schedules daily to obtain precertification.
• Work in assigned precert dept locations and make independent decisions with minimal supervision.

Job description

Pre-Certification Specialist (Ambulatory)

Support Services Center (850)

Full Time , Day Shift , M-F 8am - 4:30pm

The Precert Specialist is directly responsible and accountable to the Precertification Department Manager.The Precert Specialist will be primarily responsible for precerting outpatient procedures within the Clinic.Effectively communicate with third party payers and their Utilization Review Departments to assure procedures are authorized and medically necessary.The Precert Specialist will communicate efficiently with Clinic departments to assure precertification is obtained.Monitor Radiology schedules daily and assure precertification is obtained.Work in any assigned precert dept. location and exhibit proven ability to make logical, intelligent decisions independently with minimum supervision.