Precertification Specialist: Medical Authorization Expert

Washington Regional Medical System; Fayetteville (AR); Sur place; USD 36 000 - 48 000; Plein temps

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Medical coding

Precertification

Admissions

CPT codes

ICD-10 codes

Formation

High School Diploma or GED

Description du poste

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.