Prior Authorization & Medical Coding Specialist

promedica; Toledo (OH); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Flexible benefits

Job summary

ProMedica is seeking a Pre-Certification Specialist for the Wildwood Orthopaedic & Spine Hospital. You will perform prior authorizations and certifications for orthopaedic services with payers, ensuring coding awareness for surgeries and injections.

You should understand medical criteria for prior authorizations and maintain current knowledge of ICD-10 and CPT codes; related experience in a medical office is required.

Qualifications

• Associate degree or 5 years of Billing/Insurance Verification experience.
• Familiarity with ICD10 and CPT codes applicable to services rendered.
• 5 years of relatable or equivalent experience in medical office.

Responsibilities

• Pre-Certification Specialist performs prior authorization and certification for services with payers.
• Maintain working knowledge of medical criteria relating to prior authorization requirements by third-party payers.

Skills

Billing/Insurance Verification

ICD-10 knowledge

CPT coding familiarity

Education

Associate degree

Job description

ProMedica is seeking a Pre-Certification Specialist for the Wildwood Orthopaedic & Spine Hospital. You will perform prior authorizations and certifications for orthopaedic services with payers, ensuring coding awareness for surgeries and injections.

You should understand medical criteria for prior authorizations and maintain current knowledge of ICD-10 and CPT codes; related experience in a medical office is required.