Precertification/Authorization Specialist-1

C018 MUSC Community Physicians (MCP); United States; On-site; USD 25,000 - 39,000; Full time

Benefits offered by this job

Health, dental, vision, and life ins.

Employer Sponsored Retirement Plan

Paid time off and extended sick leave

Paid Parental Leave

Disability insurance plan options

Tuition Reimbursement

Flexible schedule options

Certification incentive program

Job summary

MUSC Community Physicians (MCP) is seeking an Eligibility Specialist to verify patient eligibility, obtain insurance benefits, and secure necessary pre-certifications and authorizations before services are delivered.

The role requires communicating with payers and clinical partners, documenting information in patient records, and ensuring compliance with payer requirements. A high school diploma is required, with opportunities for professional development and tuition reimbursement.

Qualifications

• Must verify patient eligibility and insurance benefits.
• Obtain pre-certifications, authorizations, and referrals.
• Document payer communications and ensure payer requirements are met.

Responsibilities

• Verify eligibility and benefits prior to service delivery.
• Obtain authorizations via phone, fax, or payer portals.
• Communicate with payers and clinical partners to ensure compliance.

Skills

Eligibility verification

Insurance benefits

Authorization processing

Payer communication

Healthcare revenue cycle

Education

High School Degree or Equivalent

Tools

Payer portals

EHR systems

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 and Work Experience

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

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.

Medical University of South Carolina participates in the federal E‑Verify program to confirm the identity and employment authorization of all newly hired employees.

Thank you for wanting to be part of the Medical University of South Carolina team. Whether you want to teach the next generation of health care leaders, innovate new business models, discover the next breakthrough or provide patient care, there's a role for you that fuels your passion and takes advantage of your skills. There are career opportunities available in academics, research, hospital medicine, physician practices and support services, from patient billing to IT. MUSC attracts more than $250 million annually in research funding, making it the biggest magnet for biomedical, extramural research dollars of all institutions of higher learning in South Carolina. The Clinical and Translational Science Award (CTSA) Program aims to advance clinical and translational science to increase the speed at which new treatments become available to patients. MUSC Health, the clinical enterprise, operates a 750 bed medical center, which includes a nationally recognized Children's Hospital, the Ashley River Tower (cardiovascular, digestive disease, and surgical oncology), Hollings Cancer Center (one of fewer than 70 elite National Cancer Institute designated centers), a Level I Trauma Center and the Institute of Psychiatry. In addition, there are more than 100 outreach clinics, hospital/health system affiliations, and telehealth sites. U.S. News & World Report placed us among the top one percent of all American hospitals, with 11 specialties in the top 50. The MUSC Medical Center is also one of only three Magnet designated hospitals in South Carolina.