What are the responsibilities and job description for the Precertification Specialist position at ENT Associates of Alabama?
The Precertification Specialist will be responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers. Two years of experience in a medical related field required, along with a high school diploma or GED. Two years medical prior authorization experience preferred.
The Precertification Specialist will have the following 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
This a full-time, in-person position with a Monday to Friday schedule.
Our Full-Time Employee Benefits Include:
- Health/Dental/Vision Insurance
- Paid time off (PTO)
- Holiday PTO
- 401(k) plan
- Profit sharing plan
