Precertification Specialist-1

Medical University of South Carolina; Charleston (SC); On-site; USD 25,000 - 34,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

Employer Sponsored Retirement Plan

Paid time off

Job summary

Medical University of South Carolina (MUSC) seeks an Employee for MCP who will verify eligibility and obtain insurance benefits for inpatient, outpatient, and ancillary services. This role ensures pre-certification, authorization, and referrals are completed and maintains payer communications for compliance.

Education required is a High School Degree or Equivalent; 1 year of experience is preferred. Responsibilities include determining third-party payer requirements, obtaining authorizations via

Qualifications

• High School Degree or Equivalent required.
• 1 year of work experience preferred.

Responsibilities

• Verify eligibility and obtain insurance benefits for inpatient, outpatient, and ancillary services.
• Ensure pre-certification, authorization, and referral requirements are met.
• Identify patient services with third-party payer requirements and obtain necessary authorizations.
• Document all payer communications and clinical details in the patient record.

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

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

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.