What are the responsibilities and job description for the Pre-Certification Specialist position at Nexus Pain Center?
Diagnostic Testing Precertification Specialist
DESCRIPTION
The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully
completing the authorization process.
RESPONSIBILITIES
- Prioritize incoming authorization requests according to urgency
- Obtain authorization via payer website or by phone and follow up regularly on pending cases
- 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
- 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
- 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
- 1 year’s medical prior authorization experience preferred
- 1 years’ experience in a medical related field required
Job Type: Full-time
Pay: From $16.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
Salary : $16
