Precertification Specialist (Full-time, 8:00am-4:30pm)

Washington Regional Medical System; Fayetteville (AR); On-site; USD 36,000 - 48,000; Full time

Job summary

Washington Regional Medical System in Fayetteville, AR is seeking a Pre-Certification Specialist who will use the electronic medical record system to abstract information proving medical necessity and obtain precertification before the date of service.

The role requires strong knowledge of authorizations, CPT and ICD-10 codes, and two years of medical setting experience focused on coding, admitting, or precertification.

Qualifications

• Education: High School Diploma or GED.
• Experience: 2+ years in a medical setting focused on coding, admitting or precertification.
• Familiarity with CPT and ICD-10 codes preferred.

Responsibilities

• Communicate with providers and clinic staff for reviews and preauthorization.
• Maintain knowledge of authorization and medical necessity requirements.
• Review cases for potential denials and schedule peer reviews.
• Document case outcomes in the system.
• Support scheduling/admissions with inquiries on medical necessity and authorizations.
• Collaborate across departments to ensure accuracy of authorizations.
• Complete post-procedure reviews to update authorizations.

Skills

Medical coding

Precertification

Admissions

CPT codes

ICD-10 codes

Education

High School Diploma or GED

Job description

Job Details: Job Location: Washington Regional Med. Ctr. - Fayetteville, AR, Position Type: Full Time, Education Level: High School Diploma or GED, Salary Range: Undisclosed, Job Shift: Days, Job Category: Administrative/Clerical, Organization Overview, Mission, Vision, and Values

Washington Regional Medical System (the “System”) is our region’s only locally governed, community-owned, not-for-profit healthcare system. The System includes a 425-bed acute care hospital known as Washington Regional Medical Center (the “Hospital”) which is in Fayetteville, Arkansas. The Hospital is supported by the System- including primary, specialty and urgent care operations - that span across Northwest Arkansas into Harrison and Eureka Springs. Being heavily supported and invested in our community makes Washington Regional a unique employer, encouraging staff to give back to the community in which we live and work … and give back to each other.

Washington Regional Mission, Vision and Values prove to be a firm foundation and inspiration from which we fulfill our purpose.

Mission: Washington Regional is committed to improving the health of people in communities we serve through compassionate, high-quality care, prevention, and wellness education.

Vision: To be the leading healthcare system in Northwest Arkansas --- the best place to receive care and the best place to give care.

Values: To treat others – patients and their families, visitors, physicians, and each other – as we would want to be treated.

Position Summary

The role of the Pre-Certification Specialist reports to the Scheduling Manager. This position is responsible for utilizing the electronic medical record system to abstract information to prove medical necessity to the payor and to ensure precertification for services is obtained prior to the date of service. This position is responsible for researching resolutions for authorization issues and recommends process improvement to reduce denials associated with authorizations.

Essential Position Responsibilities

• Effectively communicate with the ordering providers and/or necessary clinic staff for medical reviews and preauthorization regarding future cases
• Maintain a current working knowledge of authorization and medical necessity requirements
• Review cases for anticipated denials and schedules peer reviews
• Utilize the appropriate system to document the case outcome
• Assist the scheduling and admissions staff with inquiries regarding medical necessity and authorizations
• Collaborate with necessary departments/providers to ensure overall accuracy of authorizations
• Complete post procedure reviews to initiate updates to existing authorizations
• May be assigned specific insurance plans and provider specialties but expected to learn on the job other insurances and specialties.

Qualifications

• Education: High School Diploma or GED
• Licensure/Certifications: N/A
• Experience: Minimum of two years’ experience in a medical setting with a focus in coding, admitting, or precertification, preferred. Previous experience with CPT and ICD 10 codes, preferred.

Work Environment

This position will spend 80% of time standing and/or walking while pushing, pulling, lifting, and/or carrying up to 50 lbs. This position will spend 20% of time sitting while performing work in a standard office environment. This position will serve a culturally and linguistically diverse patient population.