Offer summary

Qualifications:

High School Diploma or GED is required., Minimum of two years' experience in a medical setting, preferably in coding, admitting, or precertification., Experience with CPT and ICD-10 coding is preferred., Ability to communicate effectively with healthcare providers and staff..

Key responsibilities:

Abstract information from electronic medical records to prove medical necessity.

Obtain precertification for services prior to the date of service.

Research and resolve authorization issues, recommending process improvements.

Collaborate with departments to ensure accurate authorizations and review cases for potential denials.

Job description

Job Details

Job Location: Washington Regional Med. Ctr. - Fayetteville, AR

Position Type: Full Time

Education Level: High School Diploma or GED

Salary Range: Undisclosed

Job Shift: Day

Job Category: Admissions & Billing Services

Description

Organization Overview, Mission, Vision, and Values

Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for four consecutive years by U.S. News & World Report. We employ 3,400+ team members and serve the region with over 45 clinic locations, the area’s only Level II trauma center, and five Centers of Excellence - the Washington Regional J.B. Hunt Transport Services Neuroscience Institute; Washington Regional Walker Heart Institute; Washington Regional Women and Infants Center; Washington Regional Total Joint Center; and Washington Regional Pat Walker Center for Seniors.

Position Summary

The role of the Pre-Certification Specialist reports to the Scheduling Manager. This position is responsible for utilizing the electronic medical record system to abstract information to prove medical necessity to the payor and to ensure precertification for services is obtained prior to the date of service. This position is responsible for researching resolutions for authorization issues and recommends process improvement to reduce denials associated with authorizations.

Essential Position Responsibilities

Effectively communicate with the ordering providers and/or necessary clinic staff for medical reviews and preauthorization regarding future cases
Maintain a current working knowledge of authorization and medical necessity requirements
Review cases for anticipated denials and schedules peer reviews
Utilize the appropriate system to document the case outcome
Assist the scheduling and admissions staff with inquiries regarding medical necessity and authorizations
Collaborate with necessary departments/providers to ensure overall accuracy of authorizations
Complete post procedure reviews to initiate updates to existing authorizations
May be assigned specific insurance plans and provider specialties but expected to learn on the job other insurances and specialties.

Qualifications

Education: High School Diploma or GED
Licensure/Certifications: N/A
Experience: Minimum of two years’ experience in a medical setting with a focus in coding, admitting, or precertification, preferred. Previous experience with CPT and ICD 10 codes, preferred.

Work Environment: This position will spend 80% of time standing and/or walking while pushing, pulling, lifting, and/or carrying up to 50 lbs. This position will spend 20% of time sitting while performing work in a standard office environment. This position will serve a culturally and linguistically diverse patient population.