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Pre-Certification Specialist

Little Rock, AR · Healthcare
Precertification Specialist
 
The Precertification Specialist essential responsibility is to ensure that all procedures, tests and surgeries are pre-certified in a timely manner.
 
Job Duties:
  • Determining if a specific procedure, test, imaging order or surgery requires precertification/prior authorization.
  • Obtains the precertification/prior authorization/pre-determination number/language and documenting this information in the patient’s chart.
  • Ensuring the test, procedure or surgery is scheduled at the appropriate facility
  • Providing the facility with the precertification information
  • Provides the patient with estimate of cost on surgeries and injectables.
  • Obtains ABN’s when needed
  • Obtains precertification DME for surgical patients.
  • Obtains CPT and ICD10 codes for pending procedures. Elicits help from CPC as needed.
  •  Obtains retro authorizations on procedures not included with initial authorization. (unexpected procedures performed).
Qualifications:
  • High School Diploma or GED
  • Minimum 1 year precertification experience in a medical office
 

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