Precertification Specialist: Streamline Medical Auth

Washington Regional; Fayetteville (AR); On-site; USD 36,000 - 54,000; Full time

Job summary

Washington Regional Medical Center in Fayetteville, AR seeks a Precertification Specialist to verify medical necessity and obtain precertifications prior to service dates, using the EMR to abstract information and resolve authorization issues.

The role supports scheduling, admissions, and multiple departments to reduce denials, requiring a high school diploma and 2+ years in a medical setting with CPT/ICD-10 familiarity.

Qualifications

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

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.

Skills

Medical coding

Precertification

Admitting

Education

High School Diploma or GED

Job description

Washington Regional Medical Center in Fayetteville, AR seeks a Precertification Specialist to verify medical necessity and obtain precertifications prior to service dates, using the EMR to abstract information and resolve authorization issues.

The role supports scheduling, admissions, and multiple departments to reduce denials, requiring a high school diploma and 2+ years in a medical setting with CPT/ICD-10 familiarity.