Pratt Regional Medical Center Job - 50238578 | CareerArc
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Company: Pratt Regional Medical Center
Location: Pratt, KS
Career Level: Associate
Industries: Healthcare, Pharmaceutical, Biotech

Description

Summary

Summary:  The pre-certification specialist is responsible for obtaining prior authorizations for all procedural and ancillary orders by successfully completing the authorization process with all required payers.

Job Duties:  

  • Review chart documentation to ensure patient meets medical necessity guidelines
  • Prioritize incoming authorization requests according to urgency
  • Obtain authorization via payer website or by phone and follow up regularly on pending cases
  • Maintain current with payer requirements needed to successfully obtain authorizations
  • Initiate appeals for denied authorizations
  • Respond to clinic questions regarding payer medical necessity guidelines
  • Confirm accuracy of CPT and ICD-10 diagnoses in the procedure orders

Compensation & Benefits:  Competitive wages and excellent fringe benefit program.  Salary commensurate with experience. 

 


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