Precertification Specialist – Scheduling (FTD)

About the role

This position is responsible for obtaining and completing all insurance precertifications and authorizations as required for various clinical procedures. The role involves determining the necessity for precertification and coordinating with insurance companies, patients, and clinical staff to obtain information. You will maintain complete and accurate documentation in patient charts and develop effective relations with insurance companies, physicians, and medical office staff.

Must have proficient knowledge of insurance requirements, medical/clinical terminology, medical necessity associated with various clinical procedure codes, and certification/referral workflow. This position requires the ability to work with minimal supervision.

Responsibilities

• Obtain and complete all insurance precertification and authorizations as required for various clinical procedures.
• Determine the necessity for precertification and coordinate with insurance companies and clinical staff to obtain information necessary to secure precertification and authorization.
• Maintain complete and accurate documentation within the patient medical record.
• Maintain proficient knowledge of insurance requirements, medical/clinical terminology, and medical necessity associated with various clinical procedures.
• Utilize clinical documentation to obtain the appropriate CPT procedure codes for various clinical procedures from coding staff as necessary.
• Exercise effective time management and prioritization skills to complete urgent precertification/authorization requests.
• Maintain proficient knowledge of certification/referral workflow.
• Develop and maintain effective relationships with physicians, medical office staff, and insurance companies.

Requirements

• High school diploma or equivalent required; Associate of Science preferred.
• Current medical assistant certification or state licensure as a Practical Nurse (or licensure from a state within the Nursing Compact) preferred but not required.
• Minimum of three years of experience in medical registration/admissions, precertification, and/or medical insurance required.

This position is designated as safety-sensitive due to the essential duties involving critical medical care to patients. A lapse in attention to detail may constitute a threat to health or safety, resulting in injury, illness, or death. This role requires working in a constant state of alertness in a safe manner.

Schedule

Monday – Friday, or as directed by department supervisor.