Position Summary:
- The Pre-Certification Specialist is responsible for supporting the Precertification Nurse, Medical Director and Director of Health Services by collecting, interpreting and evaluating medical information received for authorization.
- The Pre-cert Specialist will communicate with internal and external providers regarding authorization status.
Essential Duties and Responsibilities:
- Receive request for authorization from hospitals, providers, customers and vendors via fax, phone and portal
- Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate)
- Determine authorization requirements based on company policy, member benefit grid and provider status
- Review customer coverage and benefits
- Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Utilization Management Nurse)
- Maintain benchmark standards for TAT (Turn-Around-Time) as established by the organization.
- Professional demeanor and the ability to work effectively within a team or independently
- Flexible with the ability to shift priorities when required
- Maintains regular and acceptable attendance in accordance with Time Away From Work policy
- Ability to work evening, weekend and holiday shifts to support the UM Department
- Other duties as requested
Qualifications:
- High School Diploma and preferred 1-2 years’ experience in a managed care environment
- Proficient in medical terminology, CPT, HCPCS and ICD-10 coding
- Effective oral and written communication skills
- Strong customer orientation
- Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word
- Excellent typing skills
Knowledge, Skills, Abilities Required:
- Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a customer
- Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environment
- Proficient knowledge of departmental policies and procedures
- Knowledge of Medicare Regulatory Requirements
Amazon Fire TV Stick HD (newest model), free and live TV, Alexa Voice Remote, smart home controls, HD streaming
14% OffStream in Full HD - Enjoy fast, affordable streaming in Full HD, and control it all with the Alexa V... read more
Trump Ornament, Donald J.Trump Inauguration Day 2025, President Trump Inauguration Party Supplies, Inauguration Day Decorations, Donald Trump Gifts for Men Women
$7.99 (as of January 14, 2025 06:00 GMT -06:00 - More infoProduct prices and availability are accurate as of the date/time indicated and are subject to change. Any price and availability information displayed on [relevant Amazon Site(s), as applicable] at the time of purchase will apply to the purchase of this product.)🏛️ Commemorate Inauguration Day 2025: Celebrate Donald J. Trump’s Inauguration Day with this special... read more