Job Summary:
The Precertification Specialist II is responsible for overseeing the completion of authorizations. The Specialist acts as the liaison between providers, physicians, insurance companies, billing department, and utilization review companies to ensure the initiation and/or completion of all payers requiring precertification
Responsibilities
- Obtains, verifies, and assists in the completion of authorization
- Monitors a listing of scheduled procedures to begin and complete the authorization process
- Reviews clinical records for supporting documentation and submits to obtain authorization
- Documents accounts and charts with updated authorization statuses based on final payer responses
- Completes authorizations with no more than five incomplete authorizations within a one-year period
- Receives communication from providers and/or the provider’s staff when procedures are ordered for outside facilities
- Acts as a liaison with physician offices, insurance companies, and utilization review companies
- Reports denials and works with providers to appeal as the providers sees fit
- Gathers information requested by providers and assists by prefilling forms
- Communicates with providers regarding incomplete documentation, peer-to-peer review requests, denials and appeals
- Works in conjunction with billing departments to obtain authorizations post service initiation
- Examines past procedures for performed testing with missing authorizations
- Submits clinical documentation for retroactive or upgraded authorizations
- Collaborates with billing to obtain authorization when denials or audits are necessary due to final payer response
Qualifications
Required Qualifications:
Education: High School Diploma or GED equivalent.
Experience: Two (2) years of experience with precertification and insurance verification in a hospital or healthcare setting OR completion of LPN/RN program.
