Diagnostic Testing Precertification Specialist
DESCRIPTION
The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully
completing the authorization process.
RESPONSIBILITIES
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Prioritize incoming authorization requests according to urgency
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Obtain authorization via payer website or by phone and follow up regularly on pending cases
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Initiate appeals for denied authorizations
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Respond to clinic questions regarding payer medical policy guidelines
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Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
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Other duties as assigned
KNOWLEDGE, SKILLS, AND ABILITIES
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Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle
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Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations
effectively
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Proficient use of CPT and ICD-10 codes
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Excellent computer skills including Excel, Word, and Internet use
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Detail oriented with above average organizational skills
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Plans and prioritizes to meet deadlines
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Excellent customer service skills; communicates clearly and effectively
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Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
EDUCATION/EXPERIENCE REQUIRED
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High School Diploma or GED
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1 year’s medical prior authorization experience preferred
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1 years’ experience in a medical related field required
