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Precertification Specialist

Precertification Specialist

Specialty Orthopedic GroupUS
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Precertification Specialist Location :

  • Tupelo FLSA Status : Non-Exempt Job Type : Full-Time Position Summary : Specialty Orthopedic Group is seeking a dedicated Precertification Specialist to join our team.
  • This role is responsible for reviewing chart documentation, obtaining authorizations, and ensuring compliance with medical policy guidelines.
  • The Precertification Specialist plays a critical role in supporting clinic operations, ensuring patients receive timely authorizations, and maintaining accurate records across multiple payer systems.

Key Responsibilities :

  • Review chart documentation to ensure patients meet medical policy guidelines.
  • Prioritize incoming authorization requests according to urgency.
  • Obtain authorizations via payer websites or by phone, and follow up regularly on pending cases.
  • Maintain individual payer files with up-to-date requirements for successful authorizations.
  • Initiate appeals for denied authorizations.
  • Respond to clinic questions regarding payer medical policy guidelines.
  • Confirm accuracy of CPT and ICD-10 diagnoses in procedure orders.
  • Contact patients to discuss authorization status as needed.
  • Perform other duties as assigned.

    • Systems and Sites :

  • ModMed, MESA, Magnolia / Ambetter, RadMD, UHC, Availity, Carelon, Telligen, Evicore, Cohere, OptumVA, Humana Military, My Visco, Flex Forward, Zimmer, BV360, Turning Point, Kepro, NIA, BCBS, Cigna.

    • Qualifications :

  • High School Diploma or GED required.
  • Experience with patient registration and verification of patient information.
  • Knowledge of patient insurance eligibility checks and navigating multiple payer sites.
  • Strong organizational skills and attention to detail.
  • Excellent customer service and communication skills.
  • Ability to handle ABN forms and maintain proper documentation in patient charts.
  • Experience with case history entry, chart auditing, and quality control preferred.

    • Preferred Skills :

  • Proactive problem-solving and ability to manage multiple priorities.
  • Familiarity with medical policy guidelines, CPT / ICD-10 coding, and insurance authorization processes.
  • Strong computer literacy and ability to navigate multiple systems efficiently.
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