Precertification Specialist-1

MUSC Health; Charleston (SC); On-site; USD 25,000 - 39,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

Retirement plan

Paid time off

Paid parental leave

Disability insurance

Professional training

Competitive pay

Annual merit increase

Wellbeing resources

Tuition reimbursement

Employee perks and discounts

Employee referral program

Flexible schedule options

Certification incentive program

Job summary

MUSC Community Physicians (MCP) is seeking an eligibility and benefits verifier to ensure pre-certification and authorizations are in place before inpatient, outpatient, and ancillary services. You will liaise with payers and clinical partners to confirm coverage and deadlines, and document all interactions in the patient record.

The role is hourly with a 40-hour week, offering health/dental/vision insurance, retirement plan, paid time off, parental leave, disability coverage, and ongoing

Qualifications

• Verifies patient eligibility and benefits.
• Obtains pre-certifications, authorizations, and referrals as required.

Responsibilities

• Verify eligibility and benefits prior to services.
• Obtain necessary authorizations for care via payer portals, phone, or fax.
• Document payer communications in patient records.
• Coordinate with clinical teams to ensure payer requirements are met.
• Other duties as assigned.

Skills

Payer communication

Documentation

Attention to detail

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.

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: 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. 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