Summary : The pre-certification specialist is responsible for obtaining prior authorizations for all procedural and ancillary orders by successfully completing the authorization process with all required payers.

Job Duties :

• Review chart documentation to ensure patient meets medical necessity guidelines
• Prioritize incoming authorization requests according to urgency
• Obtain authorization via payer website or by phone and follow up regularly on pending cases
• Maintain current with payer requirements needed to successfully obtain authorizations
• Initiate appeals for denied authorizations
• Respond to clinic questions regarding payer medical necessity guidelines
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure orders

PI248530985

Last updated : 2024-09-05