Precertification/Authorization Specialist
Welcome to MUSC Health, one of the leading healthcare institutions in the nation. We are currently seeking a highly organized and detail-oriented Precertification/Authorization Specialist to join our team. As a specialist, you will play a crucial role in ensuring that our patients receive the necessary pre-approvals and authorizations for medical procedures and services. Your expertise and dedication will directly impact the quality of care we provide to our patients. To be successful in this role, you must have a strong understanding of insurance processes and possess excellent communication and problem-solving skills. Join us in making a difference in the lives of our patients.
- Review medical charts and patient information to determine the need for pre-certifications and authorizations for medical procedures and services.
- Communicate with insurance companies to obtain necessary pre-approvals and authorizations for medical procedures and services.
- Maintain accurate and detailed records of all pre-certifications and authorizations obtained, including dates, insurance company information, and any necessary documentation.
- Collaborate with healthcare providers to ensure that all necessary information and documentation is obtained for pre-certifications and authorizations.
- Educate and assist patients and their families on insurance processes and coverage limitations related to pre-certifications and authorizations.
- Monitor and track the status of all pre-certifications and authorizations to ensure timely completion and approval.
- Identify and troubleshoot any issues or discrepancies with pre-certifications and authorizations and work towards resolving them in a timely manner.
- Keep up-to-date with changes in insurance policies and procedures to ensure accurate and efficient pre-certification and authorization processes.
- Communicate with other healthcare team members to ensure a smooth and coordinated process for obtaining necessary pre-certifications and authorizations.
- Maintain confidentiality of patient information and adhere to all HIPAA regulations.
- Participate in training and development opportunities to continuously improve knowledge and skills related to pre-certifications and authorizations.
- Collaborate with the billing and coding team to ensure accurate and timely billing for pre-certified and authorized procedures and services.
- Provide excellent customer service to patients, families, and insurance companies, responding promptly and professionally to any inquiries or concerns related to pre-certifications and authorizations.
- Adhere to all hospital policies and procedures and maintain a high level of professionalism in all interactions with patients, colleagues, and insurance companies.
Knowledge Of Health Insurance Policies And Procedures: A Successful Precertification/Authorization Specialist At Musc Health Should Have A Thorough Understanding Of Various Health Insurance Plans, Including Medicare, Medicaid, And Commercial Insurance, As Well As Their Preauthorization And Precertification Requirements.
Strong Communication Skills: As A Precertification/Authorization Specialist, You Will Be Responsible For Communicating With Insurance Companies And Medical Providers To Obtain Necessary Authorizations. Excellent Communication Skills, Both Written And Verbal, Are Essential To Effectively Convey Information And Resolve Any Issues That May Arise.
Attention To Detail: The Ability To Accurately Review And Analyze Medical Records And Insurance Documents Is Crucial In This Role. Precertification/Authorization Specialists Must Pay Close Attention To Detail To Ensure All Necessary Information Is Collected And Documented Correctly.
Familiarity With Medical Terminology: A Solid Understanding Of Medical Terminology Is Necessary To Accurately Assess Medical Records And Communicate With Healthcare Providers. This Knowledge Is Also Helpful In Understanding Insurance Policies And Procedures Related To Precertification And Authorization.
Time Management And Organization Skills: The Ability To Manage Multiple Tasks And Prioritize Accordingly Is Essential In This Fast-Paced Role. Precertification/Authorization Specialists Must Be Able To Meet Deadlines And Stay Organized To Ensure A Smooth And Efficient Preauthorization And Precertification Process For Patients And Healthcare Providers.
Communication Skills
Data Entry
Time Management
Multitasking
Attention to detail
Medical Terminology
Problem-Solving
Insurance Knowledge
prior authorization
Claim Processing
Billing And Coding
Communication
Conflict Resolution
Emotional Intelligence
Leadership
Time management
creativity
Attention to detail
Teamwork
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a Precertification/Authorization Specialist in Charleston, SC, USA is between $35,000 and $55,000 per year. However, this can vary depending on factors such as years of experience, education level, and specific job responsibilities.
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