Precertification & Authorization Specialist

Carolina Orthopaedic & Neurosurgical Associates; Spartanburg (SC); On-site; USD 38,000 - 48,000; Full time

Job summary

Carolina Orthopaedic and Neurosurgical Associates seeks a Medical Office Personnel to obtain pre-certifications and authorizations for pain management procedures. The candidate should be detail-oriented, organized, and a strong team player in a fast-paced office.

Responsibilities include contacting insurers for preauthorization, following up promptly, liaising with physicians, reviewing charts for medical necessity, and documenting actions and denials.

Qualifications

• 1 to 2 years of related experience.
• 1 year precertification experience (preferred).
• Knowledge of medical terminology, insurance plans, and EMR.

Responsibilities

• Contact insurance companies to determine preauthorization requirements for diagnostic services.
• Call or use online tools to obtain preauthorization and follow up timely.
• Communicate all preauthorization issues to the physician and staff.
• Liaise with the physician’s staff to obtain additional information as needed.
• Review patient charts and submit information for medical necessity.
• Follow up on denials and peer-to-peer requests.
• Document all actions, authorizations, and denials.
• Prioritize tasks, work independently, and maintain focus under pressure.
• Communicate clearly with providers, insurance companies, and staff.
• Demonstrate excellent verbal and written communication and organizational skills.

Skills

Attention to detail

Excellent communication

Team player

EMR proficiency

Medical terminology

Organizational skills

Multi-tasking

Computer literacy

Job description

Carolina Orthopaedic and Neurosurgical Associates seeks a Medical Office Personnel to obtain pre-certifications and authorizations for pain management procedures. The candidate should be detail-oriented, organized, and a strong team player in a fast-paced office.

Responsibilities include contacting insurers for preauthorization, following up promptly, liaising with physicians, reviewing charts for medical necessity, and documenting actions and denials.