PRECERTIFICATION PRIOR AUTHORIZATION SPECIALIST, CENTRALIZED

Sgmc-Health-1; Valdosta (GA); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

401(k) with employer match

Paid Time Off

Health insurance options

Education assistance

Job summary

SGMC Health is seeking an organized administrative professional for the Central Scheduling team. You will obtain precertification and prior authorization for oncology services, ensuring timely approvals and accurate documentation across Mosaiq and HIS systems.

You will upload and verify authorization details, follow the Quality Check List, and support program development. A strong emphasis on accuracy and teamwork will be essential in this full-time on-site role.

Qualifications

• High school diploma preferred.
• Minimum 1 year of administrative experience; hospital/medical office setting preferred.
• Knowledge of insurance and managed care processes beneficial.
• Strong computer skills including MS Office and data entry.

Responsibilities

• Obtain precertification and/or prior authorization for tests, procedures, and treatments.
• Upload authorization numbers and documentation into Mosaiq and HIS (Series).
• Utilize Mosaiq QCL for monitoring authorization requests and expirations.
• Maintain accurate documentation and contribute to program development.
• Perform other duties as assigned by manager.

Skills

Communication skills

Team player

Attention to detail

Self-motivated

Adaptable

Education

High school diploma

Tools

Mosaiq

HIS (Series)

Microsoft Office

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 :

SGMC Patient Financial Services

DEPARTMENT:

CENTRAL SCHEDULING

SCHEDULE:

Full Time, 8 HR Day Shift,

POSITION SUMMARY

Responsible for obtaining precertification and/or prior authorization for each patient for which testing or procedures have been ordered by PCCC Medical Oncologists and Radiation Oncologist, including but not limited to all radiologic testing, injections, chemotherapy and/or radiation treatments, prior to services being rendered, using appropriate diagnoses and procedure codes. The precertification and/or authorization must be obtained on each patient by 2:00 p. m. on the day 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 both Mosaiq and HIS (Series) software, authorization numbers, time spans/number of procedures, etc. and supporting documentation upon verification that procedures are authorized as requested. Responsible for appropriate use of Quality Check List (QCL) in Mosaiq as notification system for the monitoring of authorization requests and expiring authorizations. Responsible for the use of and, documentation in, Mosaiq as the official medical record, following appropriate guidelines for documenting. Responsible for contributing to program development. Other duties as identified and assigned by 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 are 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.

SEE WHAT ALL OF THE HYPE IS ABOUT

https://www.youtube.com/watch?v=_DeqKw8xk54