Precertification Specialist - Washington Regional Physicians' Specialty Hospital (Full-Time, Day Shift)

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 five consecutive years by U.S. News & World Report. We employ 3,400+ team members and serve the region with over 40 clinic locations, the region’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 En