Precertification & Authorization Specialist

Marshall Health; Huntington, Northern (VA, KY); Hybrid; USD 38,000 - 52,000; Full time

Job summary

Marshall Internal Medicine in Huntington, WV, seeks a Precertification Representative to manage documentation, billing support, and prior authorizations for scheduled procedures.

Responsibilities include using electronic and manual systems to capture source documentation, communicating CPT/diagnosis details, and backing up clinics as needed; completion of a Medical Assistant or Nurse Assistant certification, plus at least one year of healthcare billing or clinical experience, is preferred.

Qualifications

• Completion of a certification program such as Medical Assistant, Nurse Assistant, or equivalent required.
• One year of billing or clinical experience in a health care organization is required.

Responsibilities

• Utilizes the necessary electronic and manual systems to identify and capture source documentation needed for the coding of ordered procedures, tests, surgeries, etc.
• Answers phone calls and/or inquiries from insurance carriers or other parties to assist in the prior authorization for scheduled procedures as necessary.
• Performs the precertification process for scheduled procedures as necessary, including communication of any balances due to the patient.
• Communicates and appropriately documents the details of the procedure authorization. Includes information such as approved CPT code, diagnosis code, and Date of Service range to entity performing the procedure and documents details of authorization in the patient medical record per approved protocols.
• Provides backup to clinics as needed.
• Performs other duties as assigned or requested.

Job description

Marshall Internal Medicine in Huntington, WV, seeks a Precertification Representative to manage documentation, billing support, and prior authorizations for scheduled procedures.

Responsibilities include using electronic and manual systems to capture source documentation, communicating CPT/diagnosis details, and backing up clinics as needed; completion of a Medical Assistant or Nurse Assistant certification, plus at least one year of healthcare billing or clinical experience, is preferred.