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

StartupNWA; Fayetteville (AR); On-site; USD 40,000 - 60,000; Full time

Job summary

Washington Regional Medical System in Fayetteville, AR, seeks a Pre-Certification Specialist to ensure medical necessity and precertification prior to service.

You will use the EMR to abstract information, resolve authorization issues, and collaborate with clinicians and admitting staff to reduce denials.

Qualifications

• High school diploma or GED required.
• Minimum of two years’ experience in a medical setting with a focus in coding, admitting, or precertification.
• Experience with CPT and ICD-10 coding preferred.

Responsibilities

• Effectively communicate with ordering providers and clinic staff for medical reviews and preauthorization.
• Maintain a current working knowledge of authorization and medical necessity requirements.
• Review cases for anticipated denials and schedule peer reviews.
• Utilize the system to document the case outcome.
• Assist scheduling and admissions staff with inquiries regarding medical necessity and authorizations.
• Collaborate with departments/providers to ensure overall accuracy of authorizations.
• Complete post procedure reviews to initiate updates to existing authorizations.

Skills

Communication

Collaboration

Attention to detail

Education

High School Diploma or GED

Tools

CPT and ICD-10 codes

Job description

Education LevelHigh School Diploma or GED## Description**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.