Precertification Specialist

MUSC Health; Charleston (SC); Presencial; USD 30.000 - 47.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health, dental, vision, and life保险

Employer Sponsored Retirement Plan

Paid time off and extended sick leave

Paid Parental Leave

Disability insurance plan options

Continuous professional and clinical培训

Competitive pay

Annual Merit Increase

Wellbeing resources

Tuition Reimbursement

Employee perks and discounts

Employee referral program

Flexible schedule option

Certification incentive program

Descripción de la vacante

MUSC Health in Charleston, SC is seeking a Precertification Specialist to verify patient eligibility, obtain insurance benefits, and ensure all pre-certification, authorization and referral requirements are met before delivering inpatient, outpatient, and ancillary services.

The role requires coordinating with payers and clinical partners, determining which services require third-party authorizations, and documenting information in the patient record.

Formación

• High School Diploma or GED required; 1 year experience preferred.
• Ability to obtain authorizations via phone, fax or payer websites.

Responsabilidades

• Verify eligibility and obtain insurance benefits prior to services.
• Ensure pre-certification, authorization and referral requirements are met for inpatient, outpatient and ancillary services.
• Identify services with third-party payer requirements and obtain necessary authorizations.
• Provide detailed, timely communication to payers and clinical partners.
• Document all information in the patient’s record.
• Other duties as assigned.

Conocimientos

Verifying eligibility

Obtaining insurance benefits

Authorization handling

Referral management

Payer communication

Documentation in patient records

Educación

High School Diploma or GED

Descripción del empleo

Job Description Summary

This role is 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

Job Description Summary

This role is 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

Medical University Hospital Authority (MUHA)

Worker Type

Employee

Worker Sub-Type

Regular

Cost Center

CC002349 CHSCorp OH - Precertification Unit

Pay Rate Type

Hourly

Pay Grade

Health-20

Scheduled Weekly Hours

40

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 option
• Certification incentive program

Additional Job Description

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