What are the responsibilities and job description for the Precertification Specialist position at ENT Associates of Alabama, P.C.?
DESCRIPTION The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers.
RESPONSIBILITIES * Review chart documentation to ensure patient meets medical policy guidelines * Prioritize incoming authorization requests according to urgency * 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 * Initiate appeals for denied 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 * Other duties as assigned
KNOWLEDGE, SKILLS, AND ABILITIES * Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle * Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively * Basic understanding of human anatomy, specifically musculoskeletal * Proficient use of CPT and ICD-10 codes * Excellent computer skills including Excel, Word, and Internet use * Detail oriented with above average organizational skills * Plans and prioritizes to meet deadlines * Excellent customer service skills; communicates clearly and effectively * Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
EDUCATION/EXPERIENCE REQUIRED * High School Diploma or GED * 2 years medical prior authorization experience preferred * 2 years experience in a medical related field required
Job Type: Full-time
Expected hours: 36 – 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- Monday to Friday
Ability to Commute:
- Birmingham, AL (Required)
Ability to Relocate:
- Birmingham, AL: Relocate before starting work (Required)
Work Location: In person
