Utilization Management Director jobs in Gulfport, MS

The Precertification Specialist II is responsible for overseeing the completion of authorizations. The Specialist acts as the liaison between providers, physicians, insurance companies, billing department, and utilization review companies to ensure the initiation and/or completion of all payers requiring precertification

Job Description:

• Obtains, verifies, and assists in the completion of authorization
  • Monitors a listing of scheduled procedures to begin and complete the authorization process
  • Reviews clinical records for supporting documentation and submits to obtain authorization
  • Documents accounts and charts with updated authorization statuses based on final payer responses
  • Completes authorizations with no more than five incomplete authorizations within a one-year period
  • Receives communication from providers and/or the provider’s staff when procedures are ordered for outside facilities
• Acts as a liaison with physician offices, insurance companies, and utilization review companies
  • Reports denials and works with providers to appeal as the providers sees fit
  • Gathers information requested by providers and assists by prefilling forms
  • Communicates with providers regarding incomplete documentation, peer-to-peer review requests, denials and appeals
• Works in conjunction with billing departments to obtain authorizations post service initiation
  • Examines past procedures for performed testing with missing authorizations
  • Submits clinical documentation for retroactive or upgraded authorizations
  • Collaborates with billing to obtain authorization when denials or audits are necessary due to final payer response

Required Qualifications:

Education: High School Diploma or GED equivalent.

Experience: Two (2) years of experience with precertification and insurance verification in a hospital or healthcare setting OR completion of LPN/RN program.

Memorial Health System has been dedicated to healing, inspiring, and transforming the health of our community since 1946. With multiple hospital facilities, outpatient surgery locations and diagnostic centers, more than 100 Physician Clinics, and post-acute services including skilled nursing, you can find your fit at Memorial.

When you join our team, you join more than 5,000 individuals committed to exceptional care. We offer several of the region's most comprehensive clinical programs and medical specialties unique to the Coast, including a Level III Neonatal ICU, state-designated Level II Trauma Center, Hyperbaric Oxygen Therapy, and Mississippi's first nationally-certified Primary Stroke Center.

At Memorial, you are valued. We know that our increasingly diverse communities need healthcare professionals that reflect their different cultural backgrounds, perspectives, and values. We acknowledge the uniqueness of all individuals, their commonalities as well as differences, all of which have shaped their lives in meaningful ways.

The development of our team members is integral to the patient care we provide. Grow your skills, and grow with Memorial.

Memorial Health System is an equal opportunity employer and does not discriminate on the basis of any legally protected status or characteristic. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.