Authorization and Precertification Specialist
4 days ago
We are a leading healthcare organization dedicated to delivering innovative patient care solutions. With multiple locations across the United States, we provide a range of services to support the health and well-being of our patients. Our commitment to quality and excellence has earned us top rankings in various specialties according to U.S. News & World Report. As a company, we strive to create a work environment that supports innovation, diversity, equity, and inclusion.
The Job Description
In this role, you will be responsible for ensuring smooth operations by managing precertification and prior authorization processes for various payors across different settings. Your expertise will help resolve referral, precertification, and prior authorization issues while meeting specific plan requirements. You will collaborate with internal stakeholders to resolve registration denials for government and non-government accounts. This involves working closely with colleagues to ensure timely resolution and accurate claims processing. Quality assurance guidelines and productivity standards will be key considerations in your daily tasks.
Key Qualifications
Applicants must hold a high school diploma or GED, along with at least 2 years of relevant experience. Alternatively, a bachelor's degree can substitute the experience requirement. Desired candidates will have prior experience in preauthorization, billing, insurance verification, and finance in a healthcare setting. Essential skills include effective communication, basic computer/keyboarding skills, and intermediate mathematical abilities. Familiarity with CPT-ICD10 codes and understanding of insurance verification and claim adjudication principles are preferred. Ideal candidates will possess strong verbal communication skills, be adaptable to ambiguity, and demonstrate good decision-making and problem-solving abilities. They should be comfortable working in a fast-paced environment with diverse perspectives and opinions.
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