The Precertification Specialist essential responsibility is to ensure that all procedures, tests and surgeries are pre-certified in a timely manner.
- 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).
- High School Diploma or GED
- Minimum 1 year precertification experience in a medical office