Pre-Certification Specialist

4 months ago


Charleston, United States CAMC Health System Full time
Job Summary

To ensure procurement of accurate pre-certification authorization/referral for applicable returning and new patients as well as review and completion of accurate, complete patient charts. Scheduling of multiple physician ordered tests, exams and surgeries where applicable.

Responsibilities
• Daily review of charts to determine if pre-certification/pre-authorization or referrals are needed. • Review specific patient insurance info to determine medical necessity requirements for specific treatments. • Correspond with medicare and various insurance companies to facilitate obtaining pertinent data on compliance, authorizations, verifications, progress notes, medical necessity guidelines and precertification and pre-authorization requirements. • Perform clerical duties as necessary, including composing letters to patients, insurance carriers and referring physicians regarding any issues. • Per physician order, schedule patient surgery and communicate all necessary information to the appropriate parties. • Make subsequent referrals to other physicians per physician review of test/scan results. • Establish new patient account in billing software upon receiving referral from physician. Forward all applicable info to appropriate personnel for inclusion in the medical chart. • Maintain continuing education treatment trends, current medical terminology used in pre-certification, and ICD-10, CPT and HCPCS codes. • Cross train for front desk and medical assistant roles. Provide back up as needed. • Schedule all procedures, collect, apply and deposit all funds.

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact)The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department's identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients.Competency StatementMust demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist.Common Duties and Responsibilities(Essential duties common to all positions)1. Maintain and document all applicable required education.2. Demonstrate positive customer service and co-worker relations.3. Comply with the company's attendance policy.4. Participate in the continuous, quality improvement activities of the department and institution.5. Perform work in a cost effective manner.6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations.7. Perform work in alignment with the overall mission and strategic plan of the organization.8. Follow organizational and departmental policies and procedures, as applicable.9. Perform related duties as assigned.

Education
• High School Diploma or GED

Credentials
• No Certification, Competency or License Required

Work Schedule: Days

Status: Full Time Regular

Location: General-MSOB

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Anita J. Ferguson anita.ferguson@camc.org

  • Charleston, United States CAMC Health System Full time

    Job Summary To ensure procurement of accurate pre-certification authorization/referral for applicable returning and new patients as well as review and completion of accurate, complete patient charts. Scheduling of multiple physician ordered tests, exams and surgeries where applicable. Responsibilities • Daily review of charts to determine if...


  • Charleston, West Virginia, United States CAMC Health System Full time

    Job SummaryTo ensure accurate pre-certification authorization/referral for returning and new patients, review and complete patient charts, and schedule physician-ordered tests, exams, and surgeries as needed.Responsibilities•Chart Review Daily review of charts to determine pre-certification/pre-authorization or referrals are needed.•Insurance Review...


  • South Charleston, United States CAMC Health System Full time

    Job Summary To ensure procurement of accurate pre-certification authorization/referral for applicable returning and new patients as well as review and completion of accurate, complete patient charts. Scheduling of multiple physician ordered tests, exams and surgeries where applicable. Responsibilities •Daily review of charts to determine if...


  • Charleston, West Virginia, United States MUSC Health & Medical University of SC Full time

    MUSC Health & Medical University of SC is seeking a skilled Radiation Therapy Specialist to join our team. Key responsibilities include administering ionizing radiation to patients under the guidance of a Radiation Oncologist, pre-treatment preparation, and ensuring accurate delivery of prescribed radiation courses. Additionally, the successful candidate...


  • Charleston, West Virginia, United States Weatherby Healthcare Full time

    Job OverviewAs a locum tenens Physician Assistant Specialist, you will have the opportunity to enjoy the freedom and flexibility of working on a part-time or temporary basis with Weatherby Healthcare. Our team is dedicated to supporting you every step of the way, ensuring that your experience is both enjoyable and rewarding.Estimated Salary: $150,000 -...


  • Charleston, United States Cherokee Federal Full time

    IT Security Specialist III Please Note: This position is pending a contract award. If you are interested in a future with Cherokee Federal, APPLY TODAY! Although this is not an approved position, we are accepting applications for this future and anticipated need. As an IT Security Specialist III at Cherokee Nation Systems Solutions (CNSS) in Charleston, SC,...


  • Charleston, United States Cherokee Federal Full time

    IT/Computer Specialist III Please Note: This position is pending a contract award. If you are interested in a future with Cherokee Federal, APPLY TODAY! Although this is not an approved position, we are accepting applications for this future and anticipated need. As an IT/Computer Specialist III at Cherokee Nation Systems Solutions (CNSS) in Charleston, SC,...

  • Nurse Specialist

    1 week ago


    Charleston, West Virginia, United States CAMC Memorial Hospital Full time

    Join a world-class medical team at CAMC Memorial Hospital as a Nurse Specialist in Cardiac Progressive Care. This rewarding opportunity offers a competitive salary and a chance to make a real difference in the lives of patients.About the JobWe are seeking an experienced Registered Nurse with a passion for cardiac care to join our team. As a Nurse Specialist,...


  • Charleston, United States Insight Global Full time

    Job DescriptionJob DescriptionJob Description:Insight Global is searching for a Precertification Specialist to assist on a 6 month contract to hire for one of our largest healthcare clients in the southeast.This person will be responsible for obtaining authorizations for all appointments, surgeries, and procedures in the Charleston, SC market. You will be...

  • GIS Specialist IV

    3 months ago


    Charleston, United States Cherokee Federal Full time

    GIS Specialist IV Please Note: This position is pending a contract award. If you are interested in a future with Cherokee Federal, APPLY TODAY! Although this is not an approved position, we are accepting applications for this future and anticipated need. This position requires an active Public Trust clearance or the ability to obtain a Public Trust...


  • Charleston, West Virginia, United States Weatherby Healthcare Full time

    **Company Overview:**We are Weatherby Healthcare, a leading provider of specialty-specific locum tenens solutions. Our team is dedicated to delivering exceptional service and support to our healthcare professionals. Estimated Salary: $150-$250 per hour, based on industry standards and location. Job Description:We are currently seeking a skilled Physician...


  • Charleston, West Virginia, United States CAMC Memorial Hospital Full time

    Seeking a dedicated Healthcare Professional to join our team at CAMC Memorial Hospital as a Telemetry Unit Specialist. This is a 13-week contract opportunity with night shifts, working 3x12-hour rotations from 7:00 PM to 7:00 AM, with options for 36 or 48-hour contracts.The ideal candidate will have a minimum of 2 years of experience and hold a valid WV or...


  • Charleston, West Virginia, United States Weatherby Healthcare Full time

    We are currently seeking a Medical Care Specialist to join our team. As a key member of our healthcare staff, you will be responsible for providing high-quality medical care to patients in various settings.Job OverviewThe ideal candidate will possess excellent clinical skills, strong communication abilities, and a passion for delivering exceptional patient...


  • Charleston, West Virginia, United States Schwan's Full time

    Unlock Your Career Potential in a Thriving CompanyWe are immediately hiring for a Route Delivery Specialist to join our dynamic team. If you're passionate about building a career with popular brands like Red Baron, Tony's, and Freschetta pizza; Mrs. Smith's and Edwards desserts; and Pagoda Asian-style snacks, this role is perfect for you.What We...


  • Charleston, West Virginia, United States Weatherby Healthcare Full time

    We are currently seeking a skilled Medical Specialist to join our team at Weatherby Healthcare. This exciting opportunity will see you working in the field of general surgery and operative trauma cases.Key ResponsibilitiesYou will be responsible for providing high-quality medical care to patients, with a focus on emergency general surgery and operative...

  • EMT or Paramedic

    4 days ago


    Charleston, South Carolina, United States Amerimed Emergency Medical Services Full time

    Amerimed Emergency Medical Services is seeking a highly skilled Medical Transport Specialist to join our team. This rewarding role offers competitive pay and a range of benefits, making it an ideal opportunity for individuals passionate about providing exceptional patient care.Compensation: $60,000 - $80,000 per yearAbout the Role: As a Medical Transport...


  • Charleston, South Carolina, United States Source Medical, LLC. Full time

    About the OpportunityWe are seeking a skilled Cardiothoracic Surgery Specialist to join our team in Charleston, SC.Job SummaryThis is a full-time employed position with Source Medical, LLC. As a Cardiothoracic Surgery Specialist, you will be responsible for assisting experienced cardiothoracic surgeons in daily operations and providing high-quality patient...


  • Charleston, West Virginia, United States Heidelberg Materials US, Inc. Full time

    **Job Title:** Concrete Delivery SpecialistHeidelberg Materials US, Inc. is seeking a skilled Concrete Delivery Specialist to join our team. As a vital member of our operations, you will be responsible for safely operating a ready mix truck to deliver concrete to various job sites.**About Us:** Heidelberg Materials North America operates over 450 locations...


  • Charleston, United States Acosta Group Full time

    Merchandiser Specialist General Information Company: PRE-US Location: CHARLESTON, South Carolina, 29406 Ref #: 77550 Function: Merchandising Employment Duration: Part-time Description and Requirements As a Premium Merchandiser Specialist, you'll represent hundreds of brands across several retail locations. You will work with a diverse set of products...


  • Charleston, West Virginia, United States US Foods Full time

    US Foods is committed to excellence and is seeking a talented Customer Experience Specialist to join our team. As a key member of our retail store, you will be responsible for delivering exceptional customer service, promoting the US Foods strategy, and upholding our Cultural Beliefs.Key Responsibilities:Ensure all customers have an outstanding US Foods...