PRECERTIFICATION PRIOR AUTHORIZATION SPEC, GENERAL SURGERY

About the Role

SGMC Health is a community-focused organization committed to excellence, team spirit, and award-winning performance. This role is based in the Professional Building within the General Surgery department, supporting the precertification and prior authorization process for patient procedures and testing.

Responsibilities

• Obtain precertification and/or prior authorization for each patient prior to services being rendered, using appropriate diagnoses and procedure codes.
• Ensure precertification/authorization is secured before the patient’s scheduled appointment; contact patients to reschedule if authorization cannot be obtained.
• Review accuracy of information received regarding precertification/authorization numbers and supporting documents.
• Upload authorization numbers, time spans, number of procedures, and supporting documentation into SGMC Health’s EHR software system upon verification.
• Monitor and track authorization requests and expiring authorizations.
• Use and document in SGMC Health’s EHR software system as the official medical record, following appropriate guidelines.
• Contribute to department development.
• Perform front office reception and various customer service duties.
• Complete other duties as identified and assigned by the Practice Manager.

Requirements

• High school graduate preferred.
• Minimum one year of prior administrative experience or equivalent, preferably in a hospital or medical office setting with working knowledge of insurance and managed care.
• Excellent computer skills, including PC and Windows literacy, Microsoft Office applications (Outlook, Word, Excel), and experience with office machines.
• Prior use of medical office software databases preferred.
• Strong communication and interpersonal skills; ability to work effectively as part of a team and respond well to supervision.
• Self-motivated with initiative to tackle important issues, problems, and tasks.
• Attention to detail is critical; ability to manage multiple tasks, meet deadlines, and adapt to variety on the job.
• Flexibility in work schedule to meet accountability expectations for operations and process management in a customer-focused environment.
• Ability to cross-train to other functions as necessary.

Benefits

• Low healthcare insurance premiums.
• 401(k) with employer match.
• Paid Time Off (PTO).
• Employee discounts.
• Company-paid life insurance.
• Short-Term and Long-Term Disability.
• Cancer Insurance.
• Accident Insurance.
• Pet Insurance.
• Tuition reimbursement.
• On-the-job training and skills development.
• Opportunities for growth and advancement.
• Employee Assistance Program.

Schedule

Full Time, 8-hour day shift: Monday–Thursday, 8:00 AM–5:00 PM; Friday, 8:00 AM–12:00 PM.

Working Conditions

Generally regular work schedule during normal office hours in a comfortable indoor setting. May be subjected to high levels of stress. Requires prolonged sitting, moderate heavy lifting (0–25 lbs.), reaching, stooping, pushing, pulling, bending, and twisting. Must be able to operate office equipment including FAX, copier, and computer.