PRECERTIFICATION PRIOR AUTHORIZATION SPEC, SPN-SCHEDULING

Job Summary

Responsible for obtaining precertification and/or prior authorization for each patient for which testing and/or procedures have been ordered by the Surgeon, prior to services being rendered, using appropriate diagnoses and procedure codes. The precertification and/or authorization must be obtained on each patient; preferably prior to their scheduled appointment. If not able to obtain precertification and/or authorization, specialist must contact the patient to reschedule their appointment.

Responsibilities

• Review for accuracy of information requested and received in regard to precertification and/or prior authorization numbers received, as well as supporting documents.
• Upload into SGMC EHR software system, authorization numbers, time spans/number of procedures, etc. and supporting documentation upon verification that procedures are authorized as requested.
• Monitor and track of authorization requests and expiring authorizations.
• Use and document in, SGMC EHR software system as the official medical record, following appropriate guidelines for documenting.
• Contribute to department development.
• Perform front office reception and various customer service duties.

Requirements

• High school graduate preferred.
• Minimum (1) year prior administrative experience or equivalent; preferable in a hospital or medical office setting to include working knowledge of insurance and managed care.
• Prior use of medical office software database preferred.

Knowledge, Skills & Abilities

• Excellent computer (technical and systems) skills & knowledge: PC and Windows literacy required, as well as Microsoft Office applications - Outlook, Word, Excel, etc. as well as a variety of other office machines.
• Excellent communication and interpersonal skills.
• Self-motivated, showing initiative to tackle important issues, problems and tasks.
• Attention to detail skills are critical; ability to manage multiple tasks, meet deadlines and be flexible in order to adapt to variety on the job.

Working Conditions

• Generally regular work schedule during normal office hours.
• Comfortable setting indoors.
• May be subjected to high levels of stress.
• Moderate heavy lifting (0-25 lbs.), reaching, stooping, pushing, pulling, bending and twisting.
• Must be able to operate office equipment to include FAX, copier, and computer.