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Plymouth Meeting

    Precertification Specialist - Plymouth Meeting, United States - Centers for Advanced Urology

    Centers for Advanced Urology
    Centers for Advanced Urology Plymouth Meeting, United States

    4 weeks ago

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    Description

    Job Description

    Job DescriptionDescription:Precertification Specialist

    Plymouth Meeting, PA

    DescriptionPrecertification Specialist

    Plymouth Meeting, PA

    Description

    MidLantic Urology was founded on the desire to advance urology health care for our patients. Our merger of the top urology groups in Philadelphia not only gives us the most recognizable and skilled urologists but also empowers us with the resources to continue to innovate with the most advanced treatments backed by clinical research.

    We offer a competitive salary along with a medical comprehensive medical benefit package including 7 medical plans from which to choose, dental, company paid life insurance & disability, paid time off, 401K Plan and more

    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.


    Requirements:Requirements

    EDUCATION/EXPERIENCE REQUIRED
    • High School Diploma or GED.
    • 2 years medical prior authorization experience preferred.
    • 2 years experience in a medical related field required

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