Reimbursement Specialist - Healthcare jobs in Charleston, SC

Position: Pre-Certification Specialist

Department: Finance

Reports to: Reimbursement Director

FLSA Status: Non-exempt

Pay Type: Hourly

Position Type: Full-time

Effective Date: 2/20/24

Position Summary:

Responsible for working directly with insurance companies and obtaining approval for various procedures scheduled by SSI providers.

Working Conditions:

Sitting, standing, walking, bending, stooping, twisting, reaching overhead and lifting up to 40lbs.

Primary duties include, but are not limited to:

Review chart documentation to ensure patient meets medical policy guidelines

• Prioritize incoming authorization requests according to urgency
• Obtain authorization via payer website or by phone and follow up regularly on pending cases
• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
• Initiate appeals for denied authorizations
• Respond to clinic questions regarding payer medical policy guidelines
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Contact patients to discuss authorization status
• Other duties as assigned

· Per-certify all Practice procedures

• Verify benefits for patients
• Work with Receptionist and Medical Assistants on schedule conflicts, benefits and deductibles, and surgery patients
• Report denials to Medical Assistants

· Calculate percentages for payments and report amounts to be collected

Position Requirements:

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle

• Understanding of payer medical policy guidelines

• Basic understanding of human anatomy, specifically musculoskeletal

• Proficient use of CPT and ICD-10 codes

• Excellent computer skills including Excel, Word, and Internet use

• Detail oriented with above average organizational skills

• Plans and prioritizes to meet deadlines

• Excellent customer service skills; communicates clearly and effectively

• Ability to multitask and remain focused while managing a high-volume, time-sensitive workload

EDUCATION/EXPERIENCE REQUIRED

• High School Diploma or GED

• 2 years medical prior authorization experience preferred

• 2 years experience in a medical related field required

Job Type: Full-time

Pay: $18.00 - $23.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Experience:

• ICD-10: 1 year (Required)

Ability to Relocate:

• Mount Pleasant, SC 29464: Relocate before starting work (Required)

Work Location: In person