Diagnostic Precert Specialist

Precertification Specialist Job Description 

Full-time precertification specialist needed for multidisciplinary medical practice. Medical Office Personnel with administrative responsibilities focuses on obtaining pre-certifications and authorizations for diagnostic procedures for our orthopedic, neurosurgical, and pain management physicians.  The candidate must be detail-oriented, focused, organized, and a team player with an attitude to contribute meaningfully to the practice.  

Responsibilities:

• Contacts insurance companies and other third-party payers to determine preauthorization requirements for diagnostic services.  
• Calls insurance companies or uses online tools to obtain preauthorization. Follows up timely and thoroughly.  
• Ensures all preauthorization issues are communicated in a timely manner.  
• Liaisons with the physician’s staff to obtain additional insurance and/or clinical information.  
• Reviews patients' charts and submits appropriate and pertinent information from the clinicals for medical necessity for the service.  
• ​Follows up properly on all denials and peer-to-peer requests.  
• Documents appropriately regarding all actions, authorization, and denials.  

Qualifications:  

• Able to prioritize, work accurately, work well independently and able to maintain focus under pressure  
• Working knowledge of medical terminology, insurance packages/plans and proficient with EMR  
• Clearly communicate with providers, insurance companies and staff.  
• Excellent verbal and written communication skills  
• Excellent organizational skills, multi-tasking capabilities and detail orientated  
• Customer Services skills  
• Basic Computer/PC and Internet skills  
• Attention to details and problem-solving skills  
• Must be a great team player  
• High School Diploma (Required) 
• 1 year precertification experience (preferred) 

Monday – Friday  8am – 5pm