Precertification Specialist-1

C018 MUSC Community Physicians (MCP); United States; On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

Retirement plan

Paid time off

Parental leave

Disability insurance

Tuition reimbursement

Job summary

MUSC Community Physicians (MCP) in South Carolina seeks a payer specialist responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification and authorizations are met for inpatient, outpatient, and ancillary services.

The role requires determining which services have third party payer requirements and obtaining necessary authorizations via phone, fax, or payer portals, while communicating with payers and clinical partners to ensure contract compliance.

Qualifications

• High School Degree or Equivalent.
• 1 year of work experience in related role.
• Experience communicating with payers and clinical partners.

Responsibilities

• Verify eligibility and obtain insurance benefits, ensuring pre-certification and authorizations are met.
• Determine which patient services have payer requirements and obtain authorizations via phone, fax, or payer websites.
• Provide timely communication to payers and clinical partners to ensure payer contractual compliance and document in patient records.
• Other duties as assigned.

Skills

Eligibility verification

Payer communication

Documentation in EMR

Education

High School Diploma or GED

Tools

Payer portals

Job description

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.

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

Equal Opportunity Employer

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

Thank you for wanting to be part of the Medical University of South Carolina team. Whether you want to teach the next generation of health care leaders, innovate new business models, discover the next breakthrough or provide patient care, there's a role for you that fuels your passion and takes advantage of your skills. There are career opportunities available in academics, research, hospital medicine, physician practices and support services, from patient billing to IT. As an applicant, you can search jobs for all MUSC entities as well as search by category and location. MUSC attracts more than $250 million annually in research funding, making it the biggest magnet for biomedical, extramural research dollars of all institutions of higher learning in South Carolina. The Clinical and Translational Science Award (CTSA) Program aims to advance clinical and translational science to increase the speed at which new treatments become available to patients. MUSC Health, the clinical enterprise, operates a 750 bed medical center, which includes a nationally recognized Children’s Hospital, the Ashley River Tower (cardiovascular, digestive disease, and surgical oncology), Hollings Cancer Center (one of fewer than 70 elite National Cancer Institute designated centers), a Level I Trauma Center and the Institute of Psychiatry. In addition, there are more than 100 outreach clinics, hospital/health system affiliations, and telehealth sites. U.S. News & World Report placed us among the top one percent of all American hospitals, with 11 specialties in the top 50. The MUSC Medical Center is also one of only three Magnet designated hospitals in South Carolina.