Precertification & Authorization Specialist

C018 MUSC Community Physicians (MCP); United States; On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

Retirement plan

Paid time off

Parental leave

Disability insurance

Tuition reimbursement

Job summary

MUSC Community Physicians (MCP) in South Carolina seeks a payer specialist responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification and authorizations are met for inpatient, outpatient, and ancillary services.

The role requires determining which services have third party payer requirements and obtaining necessary authorizations via phone, fax, or payer portals, while communicating with payers and clinical partners to ensure contract compliance.

Qualifications

• High School Degree or Equivalent.
• 1 year of work experience in related role.
• Experience communicating with payers and clinical partners.

Responsibilities

• Verify eligibility and obtain insurance benefits, ensuring pre-certification and authorizations are met.
• Determine which patient services have payer requirements and obtain authorizations via phone, fax, or payer websites.
• Provide timely communication to payers and clinical partners to ensure payer contractual compliance and document in patient records.
• Other duties as assigned.

Skills

Eligibility verification

Payer communication

Documentation in EMR

Education

High School Diploma or GED

Tools

Payer portals

Job description

MUSC Community Physicians (MCP) in South Carolina seeks a payer specialist responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification and authorizations are met for inpatient, outpatient, and ancillary services.

The role requires determining which services have third party payer requirements and obtaining necessary authorizations via phone, fax, or payer portals, while communicating with payers and clinical partners to ensure contract compliance.