What are the responsibilities and job description for the Pre-certification Specialist position at Pratt Regional Medical Center?
Summary
Summary: The pre-certification specialist is responsible for obtaining prior authorizations for all procedural and ancillary orders by successfully completing the authorization process with all required payers.
Job Duties:
- Review chart documentation to ensure patient meets medical necessity guidelines
- Prioritize incoming authorization requests according to urgency
- Obtain authorization via payer website or by phone and follow up regularly on pending cases
- Maintain current with payer requirements needed to successfully obtain authorizations
- Initiate appeals for denied authorizations
- Respond to clinic questions regarding payer medical necessity guidelines
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure orders
Compensation & Benefits: Competitive wages and excellent fringe benefit program. Salary commensurate with experience.
ODA Certification Coordinator Aircraft Certification
Garmin -
Wichita, KS
