Precertification Coordinator

Central Ohio Primary Care is seeking a skilled Medical Claims Specialist to join our team in the Precertification Department. As a Medical Claims Specialist, you will play a crucial role in processing orders for high-tech radiology, cardiac testing, and medication prior authorizations.

• Order Processing: Process routine orders in a timely manner, identifying urgent orders and processing them on the same day received.
• Insurance Verification: Verify insurance eligibility and complete pre-certifications as needed.
• Clinical Data Compilation: Compile all clinical data required to support the criteria set forth by each payor's guidelines.
• Provider Communication: Communicate with ordering providers to obtain additional clinical clarification or information before submitting requests.
• Case Follow-up: Follow up on pending cases and respond to assigned telephone encounters, accurately documenting all activity related to the case.
• Team Collaboration: Collaborate with the team to distribute workload and prioritize department needs.
• Meetings and Training: Attend department and other related meetings to stay updated on policies and procedures.

• Education: High School Diploma or Equivalent.
• Experience: Minimum 2 years of precertification and electronic health record experience preferred.
• Skills: Excellent organization, written, and communication skills. Ability to work in a fast-paced environment while following policies and procedures accordingly.
• Personal Qualities: Punctual, dependable, positive, and dedicated. Proficient computer skills. Strives daily to provide exemplary customer care to COPC's patients.