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Wellstar Health System is a nonprofit healthcare system offering a range of medical services at locations throughout Georgia. The largest nonprofit health syste
WMG Precertification Specialist I
Location
United States
Posted
18 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
WMG Precertification Specialist I
Wellstar Health System
Role Description A WMG Pre-certification Specialist I is responsible for obtaining pre-certification/authorization for outpatient diagnostic procedures for practice and HOD visits and ensuring referrals are completed timely. The position reports directly to the WMG Central Precertification Manager. - Provides outstanding customer service to their dedicated physician practice. - Supports practice volumes and increasing revenues by obtaining Pre-Authorization for outpatient testing, outpatient diagnostic, and medications in a timely manner. - Maintains the required 3-day lead time ahead of the practice's schedule. - Consistent review of payer authorization policies to ensure all procedures are authorized in a timely manner. - Utilizes various departmental tools and appropriate reports to identify and trend ongoing issues with payers and physician practice processes resulting in fatal denials. - Works with physicians, nurses, clinic managers, and financial advocates to resolve issues during the prior authorizations process. - May support Pre-Registration including preparing patient estimates. - Maintains established productivity benchmarks and meets goals in a fast-paced environment. - Other duties as assigned. Qualifications - High School Diploma or GED required; Associates preferred. - Minimum 1 year experience in customer service and/or healthcare setting required. - Minimum 1 year computer/data entry experience or experience in insurance/benefits preferred. - Ability to communicate with various members of the healthcare team. - Effective communication skills (both written and verbal). - Attention to detail and self-directed with a positive attitude. - Effective problem-solving and critical thinking skills. - Working knowledge of patient registration systems. Requirements - Knowledge of all outpatient procedures. - Review and analyze medical record documentation for various medical and surgical procedures requiring authorization. - Demonstrate understanding of scheduling and updating patient insurance information. - Ensures all authorizations are requested with the appropriate CPT codes, diagnosis codes, and/or reasons for procedures (ICD-10). - Acts as the liaison between the specialist, primary care physician, and insurance carrier. - Knowledge of various insurance programs offered by each carrier (TPA). - Knowledge of Medicare guidelines regarding surgeries and procedures that require medical necessity checks. - Knowledge of insurance carriers' requirements for pre-authorization of surgeries and procedures. - Ability to type with a high degree of accuracy and computer skills to input data accurately. - Maintain accurate and thorough notes when updating authorization status. - Excellent communication and interpersonal skills. - Superior attention to detail. - Responsible for meeting the demands of the assigned facility schedule. - Ability to exercise judgment in taking appropriate actions in emergent situations. - Maintain neat attire, hair, and appearance, following the department dress code. - Acts in a way that demonstrates deep personal integrity. Benefits - Support to do more meaningful work. - Enjoy a more rewarding life. - Connect with the most integrated health system in Georgia.
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Specialist in Psychiatry and Psychotherapy
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