PRECERTIFICATION PRIOR AUTHORIZATION SPEC, GENERAL SURGERY

SGMC Health Careers; Valdosta (GA); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Health insurance

401(k)

Paid Time Off

Employee discounts

Company paid life insurance

Disability insurance

Cancer Insurance

Accident Insurance

Tuition Reimbursement

On-the-job training

Job summary

SGMC Health seeks an administrative professional to handle precertification and prior authorization for surgeries and tests. You will verify patient information, upload authorization numbers to the EHR, and track timeframes and expirations.

The role includes front desk duties and teamwork within Medical Services. Candidates should have a high school diploma and at least one year of hospital/medical office admin experience, with strong computer and communication skills to thrive in a fast-paced

Qualifications

• High school graduate preferred with 1 year of admin experience in hospital or medical office.
• Strong computer skills including Outlook, Word, Excel; familiarity with medical software is a plus.
• Excellent communication and teamwork skills, detail orientation, and reliability.

Responsibilities

• Obtain precertification and/or prior authorization for testing and procedures.
• Contact patients to reschedule if authorization cannot be obtained prior to appointment.
• Review accuracy of information for precertification numbers and documentation.
• Upload authorization details and supporting docs into SGMC Health EHR system.
• Monitor and track authorization requests and expiring authorizations.
• Document in official medical record and support department development.
• Perform front office reception and various customer service duties.

Skills

Administrative experience

Communication

Teamwork

Attention to detail

Education

High school diploma

Tools

Microsoft Office

Medical office software

Job description

Description

WHAT IT'S LIKE AT SGMC HEALTH

Purpose

No matter your role or area that you work in, at SGMC Health we are collectively working towards goals that will make our community a better place.

Excellence

We strive to do the right thing the right way, are accountable in all we do, require competence of our people, and are compassionate in our service.

Team Spirit

We encourage team effort, support personal and professional development, acknowledge individual talents and skills, and support innovation and empowerment.

Award Winning Performance

We are committed to providing the best care possible and we are proud to be recognized locally, statewide, and nationally for the exceptional care that our staff provides.

WHY YOU WILL LOVE SGMC HEALTH

SGMC has great benefit options, depending on the role that you are going into– including healthcare, supplementary benefits, ways to save for the future, opportunities for career advancement, and opportunities to expand your skill set. Some of these great benefit options are listed below:

• Low Healthcare Insurance Premiums
• 401(k) with employer match
• Paid Time Off (PTO)
• Employee discounts
• Company paid life insurance
• Short-Term and Long-Term Disability
• Cancer Insurance
• Accident Insurance
• Pet Insurance
• Tuition Reimbursement
• On-the-job training and skills development
• Opportunities for growth and advancement
• Employee Assistance Program

JOB LOCATION : Professional Building

DEPARTMENT: SPN - GENERAL SURGERY

SCHEDULE: Full Time, 8 HR Day Shift, 8-5 M-Th, 8-12 Fri

POSITION SUMMARY

Responsible for obtaining precertification and/or prior authorization for each patient for which testing and/or procedures have been ordered by the Surgeon, prior to services being rendered, using appropriate diagnoses and procedure codes. The precertification and/or authorization must be obtained on each patient, preferably prior to their scheduled appointment. If not able to obtain precertification and/or authorization, specialist must contact the patient to reschedule their appointment. Responsible for reviewing for accuracy of information requested and received in regard to precertification and/or prior authorization numbers received, as well as supporting documents. Responsible for uploading into SGMC Health EHR software system, authorization numbers, time spans/number of procedures, etc. and supporting documentation upon verification that procedures are authorized as requested. Responsible for monitoring and tracking of authorization requests and expiring authorizations. Responsible for the use of and, documentation in, SGMC Health EHR software system as the official medical record, following appropriate guidelines for documenting. Responsible for contributing to department development. Perform front office reception and various customer service duties. Other duties as identified and assigned by Practice Manager.

KNOWLEDGE, SKILLS & ABILITIES

High school graduate preferred. Minimum (1) year prior administrative experience or equivalent; preferable in a hospital or medical office setting to include working knowledge of insurance and managed care. Must have excellent computer (technical and systems) skills & knowledge: PC and Windows literacy required, as well as Microsoft Office applications - Outlook, Word, Excel, etc. as well as a variety of other office machines. Prior use of medical office software database preferred. Must possess excellent communication and interpersonal skills and must be able work effectively as part of a team and respond well to supervision. Self-motivated, showing initiative to tackle important issues, problems and tasks. Attention to detail skills is critical; ability to manage multiple tasks, meet deadlines and be flexible in order to adapt to variety on the job; ability to cross train to other functions as necessary. Requires flexibility in work scheduled for accountability expectations for operations and process management in a customer focused business.

WORKING CONDITIONS - ADA INFORMATION

Generally regular work schedule during normal office hours. Comfortable setting indoors. May be subjected to high levels of stress. Must be able to sit for prolonged periods of time. Moderate heavy lifting (0-25 lbs.), reaching, stooping, pushing, pulling, bending and twisting. Must be able to operate office equipment to include FAX, copier, and computer.