Precertification Specialist (MCP)

Job Description Summary

MUSC Community Physicians (MCP) is an entity within the Medical University of South Carolina that provides healthcare to patients within the rural health network throughout the state of South Carolina.

The Precertification Specialist report to the Precertification Supervisor. Under indirect supervision, the Precertification Specialist perform pre-certification functions to ensure that all services requiring carrier authorizations are approved.

Entity

MUSC Community Physicians (MCP)

Worker Type

Employee

Worker Sub-Type

Regular

Cost Center

CC005367 MCP - Bluffton Sleep Center

Pay Rate Type

Hourly

Pay Grade

Health-20

Scheduled Weekly Hours

40

Work Shift

Job Description

• Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care, via phone, fax, or payer websites. The Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. Other duties as assigned.

Minimum Education and Experience:

• High school diploma or equivalent (GED) and two years’ work experience in hospital registration, insurance, or financial counseling required; a bachelor's degree may be substituted for the required work experience.
• Previous work experience in pre-certification and knowledge of medical terminology highly preferred.

Required Licensure, Certifications, Registrations:

• Patient Access Certification preferred

Additional Job Description

Benefits:

• Health, dental, vision, and life insurance
• Employer Sponsored Retirement Plan
• Paid time off and extended sick leave
• Paid Parental Leave
• Disability insurance plan options
• Continuous professional and clinical training
• Competitive pay
• Annual Merit Increase
• Wellbeing resources
• Tuition Reimbursement
• Employee perks and discounts
• Employee referral program
• Flexible schedule options
• Certification incentive program

• Ability to perform job functions while standing and sitting. Ability to perform job functions while walking and climb stairs. Ability to work from elevated areas. Ability to work in confined/cramped spaces. Ability to perform job functions from kneeling positions. Ability to bend and twist at the waist. Ability to squat and perform job functions. Ability to perform gross motor activities with fingers and hands. Ability to perform firm grasping with fingers and hands. Ability to reach overhead. Ability to perform repetitive motions with hands/wrists/elbows and shoulders. Ability to use lower extremities for balance and coordination. Ability to reach in all directions. Ability to lift and carry 50 lbs. unassisted. Ability to lift/lower objects 50 lbs. from/to floor from/to 36 inches unassisted. Ability to lift from 36" to overhead 25 lbs. Ability to exert up to 50 lbs. of force. Examples include: To transfer a 100 lb. patient that cannot assist in the transfer requires 50 lbs. of force. For every 100 additional pounds, assistance will be required from another healthcare worker. 20 lbs. of force are needed to push a 400 lb. patient in a wheelchair on carpet. 25 lbs. of force are required to push a stretcher with a patient with one hand. Ability to maintain 20/40 vision, corrected, in one eye or with both eyes. Ability to see and recognize objects close at hand or at a distance. Ability to match or discriminate between colors. Ability to determine distance/relationship between objects; depth perception. Ability to maintain hearing acuity, with correction. Ability to perform gross motor functions with frequent fine motor movements. Ability to deal effectively with stressful situations. Ability to work rotating shifts. Ability to work overtime as required. Ability to work in a latex safe environment. Ability to maintain tactile sensory functions. * *Ability to maintain good olfactory sensory function. * *Ability to be qualified physically for respirator use, initially and as required.

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees