Senior Precertification Specialist
Senior Precertification Specialist
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Salary Not Disclosed
1 Vacancy
Job Description
The SeniorPrecertification Specialistwill complete the duties of the Precertification Specialists as well as the following...
- Advanced Case Management: Analyze complex prior authorization cases proactively identifying potential coverage challenges and working with payers to secure timely approvals.
- Leadership & Mentorship: Serve as a resource for junior team members providing guidance on payer policies medical necessity reviews and best practices. Assist in training new employees.
- Process Optimization: Identify inefficiencies in prior authorization workflows and collaborate with leadership to implement process improvements that support faster authorizations and reduce denials.
- Interdepartmental Collaboration: Act as a liaison between the precertification team clinical staff billing department and scheduling teams ensuring smooth communication and coordination for authorizationrelated matters.
- Compliance & Policy Adherence: Maintain uptodate knowledge of payer policies Medicare guidelines and NCCN protocols. Provide recommendations on adjustments to internal procedures to maintain compliance.
- Escalation & Resolution: Handle escalated cases requiring appeals medical director reviews and direct payer negotiations for highpriority authorization requests.
Qualifications:
- 35 years experience in a physician practice or healthcare setting performing prior authorization activities with oncology experience preferred.
- Extensive knowledge of health insurance regulations including payerspecific authorization policies.
- Proficiency in ICD10 and CPT coding with demonstrated expertise in oncologyrelated coding and medical necessity review.
- Advanced proficiency in EMR systems practice management software and Microsoft Office applications (Outlook Word Excel).
- High school diploma or GED required; additional certification in medical billing coding or healthcare administration preferred.
Required Experience:
Senior IC
Employment Type
Full-Time
