Precertification/Authorization Specialist-1

Medical University of South Carolina (MUSC); Charleston (SC); On-site; USD 23,000 - 37,000; Full time

Benefits offered by this job

Health insurance

Retirement plan

Paid time off

Parental leave

Disability insurance

Training and development

Competitive pay

Annual merit increase

Wellbeing resources

Tuition reimbursement

Employee perks and discounts

Referral program

Flexible schedule

Certification incentive

Job summary

MUSC Community Physicians (MCP) seeks an Eligibility Verification Specialist to verify patient eligibility, obtain insurance benefits, and secure required pre-certifications, authorizations, and referrals for inpatient, outpatient, and ancillary services. The role requires clear communication with payers and clinical partners, accurate documentation in patient records, and adherence to payer contracts.

Education: High School Degree or Equivalent; Experience: 1 year; 40-hour week, hourly pay

Qualifications

• High School Diploma or equivalent required.
• Minimum 1 year of related work experience.

Responsibilities

• Verify patient eligibility and obtain insurance benefits.
• Ensure pre-certification, authorization, and referral requirements are met for inpatient, outpatient, and ancillary services.
• Communicate with payers and clinical partners to satisfy payer contractual requirements and document information in patient records.

Education

High School Degree or Equivalent

Job description

Job Description Summary

MUSC Community Physicians (MCP) is an entity within the Medical University of South Carolina (MUSC) that provides healthcare to patients within the rural health network throughout the state of South Carolina.

Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services.

Entity
MUSC Community Physicians (MCP)

Worker Type
Employee

Worker Sub-Type
Regular

Cost Center
CC004513 MCP - Revenue Cycle

Pay Rate Type
Hourly

Pay Grade
Health-20

Scheduled Weekly Hours
40

Work Shift

Job Description

Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care, via phone, fax, or payer websites. The Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. Other duties as assigned.

Education: High School Degree or Equivalent

Work Experience: 1 year

Benefits

• Health, dental, vision, and life insurance
• Employer Sponsored Retirement Plan
• Paid time off and extended sick leave
• Paid Parental Leave
• Disability insurance plan options
• Continuous professional and clinical training
• Competitive pay
• Annual Merit Increase
• Wellbeing resources
• Tuition Reimbursement
• Employee perks and discounts
• Employee referral program
• Flexible schedule options
• Certification incentive program

Additional Job Description
Education: High School Degree or Equivalent Work Experience: 1 year

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees