Precertification/Authorization Specialist
| Company | Medical University of South Carolina |
|---|---|
| Location | Florence, SC, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | |
| Experience Level | Junior |
Requirements
- High School Diploma or equivalent required
- At least 1 year experience in related field required
- Knowledge of insurance authorization, ICD-10 codes, CMS regulations, guidelines highly desired
Responsibilities
- Obtain prior authorization from payers for Radiation Oncology procedures/treatments
- Assist in training authorization functions
- Serve as a resource to other departments with questions on authorizations
- Guide staff, providers, and/or patients on options when authorization cannot be obtained
- Perform charge reconciliation by ensuring Radiation Oncology procedure charges are properly posted
- Provide coding services and verification by reviewing patients’ medical records and translating information into codes
- Confirm treatments with medical staff, identify missing information, and submit forms to insurers for reimbursement
Preferred Qualifications
- Associate’s degree or 5 years’ experience in related field preferred