Precertification Specialist/Scheduler

Entalabama; St. Vincent (MN); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

401(k)

Health insurance

Life insurance

Paid time off

Vision insurance

Job summary

Entalabama is seeking a Precertification Specialist/Scheduler to coordinate surgery scheduling and obtain prior authorizations from commercial payers. The role requires two years in a medical-related field and a high school diploma or GED. You will review charts for policy compliance, discuss pre- and post-op instructions, and manage payer authorizations daily.

The position is full-time and in-person, with a Monday–Friday schedule. Benefits include 401(k), health, life, PTO, and vision insurance.

Qualifications

• Two years of experience in a medical-related field required.
• High school diploma or GED required.
• General knowledge of surgery scheduling, medications and medical terminology required.
• Two years of medical prior authorization experience preferred.

Responsibilities

• Schedule surgeries for doctors and create daily clinic schedule.
• Review chart documentation to ensure patient meets medical policy guidelines.
• Discuss pre-op and post-op instructions with patients.
• Prioritize incoming authorization requests according to urgency.
• Collect deductibles/costs for each surgery.
• Obtain authorization via payer website or by phone and follow up on pending cases.
• Maintain payer files with up-to-date authorization requirements.
• Respond to clinic questions about payer medical policy guidelines.
• Confirm CPT and ICD-10 accuracy in procedure orders.
• Contact patients to discuss authorization status.
• Answer patients’ questions about surgery/test/referral.
• Other duties as assigned.

Skills

Medical terminology

Surgery scheduling

Prior authorization

Communication

Education

High school diploma or GED

Tools

Payer websites

Job description

The Precertification Specialist/Scheduler will be responsible for scheduling procedures and obtaining prior authorizations by successfully completing the authorization process with all commercial payers.

Two years of experience in a medical-related field are required, along with a high school diploma or GED. General knowledge of surgery scheduling, medications and medical terminology required, and two years of medical prior authorization experience preferred.

This role will have the following responsibilities:

• Schedule surgeries for each doctor and create daily clinic schedule
• Review chart documentation to ensure patient meets medical policy guidelines
• Discuss Pre-op and Post-op instructions with each patient
• Prioritize incoming authorization requests according to urgency
• Collect deductibles/costs for each surgery
• Obtain authorization via payer website or by phone and follow up regularly on pending cases
• Maintain individual payer files to include up-to-date requirements needed to successfully obtain authorizations
• Respond to clinic questions regarding payer medical policy guidelines
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Contact patients to discuss authorization status
• Answer all patients’ questions about surgery/test/referral in a kind/understanding manner
• Other duties as assigned

This a full-time, in-person position with a Monday to Friday schedule.

Our Full-Time Employee Benefits Include:

• 401(k)
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Our Full-Time Employee Benefits Include:

• Paid time off (PTO)
• Holiday PTO
• 401(k) plan
• Profit sharing plan