Precertification Specialist Trauma Full Time

Position Goal

Complete the precertification and prior authorization process by calling insurance companies, adjusters, and patients. Communicate the approval or denial of surgeries and/or tests effectively to physicians, physicians' staff, and patients.

Position Responsibilities

• Responsible for obtaining precertification and prior authorization for patients scheduled for a surgical procedure, office visit, and/or tests as ordered by physician/APP in a timely manner and follow the process until completion
• Responsible for obtaining all necessary information required to obtain precertification or prior authorization to include clinical dictation and test results
• Provide accurate information to insurance companies based on test results, clinical dictation, etc.
• Verify/re-verify insurance benefits and eligibility for each scheduled surgical procedure and/or test
• Enter authorizations obtained into Athena as per policy and procedure
• Follow-up with provider for any needed information if authorization is denied and/or facilitate peer to peer as warranted.

Experience: One year of medical insurance and medical terminology experience required. Computer skills required.
Education: High School diploma or equivalent required.
Special Qualifications: Must be able to work independently and have working knowledge of HIPAA requirements.

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or protected veteran status. This company is a VEVRAA Federal Contractor.