Precertification Coordinator JobAtlanta, GA 402795147

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Why You'll Love This Job

The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers.

Responsibilities:

• Review chart documentation to ensure patient meets medical policy guidelines
• Prioritize incoming authorization requests according to urgency
• Obtain authorization via payer website or by phone and follow up regularly on pending cases
• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
• Initiate appeals for denied authorizations
• Respond to clinic questions regarding payer medical policy guidelines
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Contact patients to discuss authorization status
• Other duties as assigned

 

Knowledge, Skills, and Abilities:

• Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle
• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
• Basic understanding of human anatomy, specifically musculoskeletal
• Proficient use of CPT and ICD-10 codes
• Excellent computer skills including Excel, Word, and Internet use
• Detail oriented with above average organizational skills
• Plans and prioritizes to meet deadlines
• Excellent customer service skills; communicates clearly and effectively
• Ability to multitask and remain focused while managing a high-volume, time-sensitive workload

Education/Experience Required:

• High School Diploma or GED
• 2 years medical prior authorization experience preferred
• Nextgen experience preferred

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