What are the responsibilities and job description for the PRECERT SPECIALIST position at Oxford Orthopaedic&Sports Medicine, PLLC?
Job Description
Job Description
SUMMARY 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
- Schedule Peer to Peer calls as needed
- 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
EDUCATION / EXPERIENCE REQUIRED
