Precertification/Authorization Specialist/Full Time (Florence, SC)

Job Description Summary

Full Time Prior Authorization Representative (Radiation/Oncology) for MUSC/Florence, SC.

Entity

Medical University Hospital Authority (MUHA)

Worker Type

Employee

Worker Sub-Type​

Regular

Cost Center

CC001284 FLO - Radiation Oncology (FMC)

Pay Rate Type

Hourly

Pay Grade

Health-20

Scheduled Weekly Hours

40

Work Shift

Job Description

The Authorization Representative is responsible for obtaining prior authorization from payers for Radiation Oncology procedures/treatments. This role is key to securing reimbursement and minimizing organizational write offs. The incumbent will assist in training authorization functions and serve as a resource to other departments with questions on authorizations. When an authorization cannot be obtained, the Authorization Representative must be able to guide staff, providers, and/or patients on the options and complete the necessary steps to bring closure to the case. Perform charge reconciliation by ensuring Radiation Oncology procedure charges are properly posted. As needed, provide coding services and verification by reviewing the patients’ medical record after a visit and translating the information into codes that insurers use to process claims from patients. Their duties include confirming treatments with medical staff, identifying missing information and submitting forms to insurers for reimbursement. Other duties as deemed necessary.

Education: High School Diploma or equivalent required, associate's degree or 5 years’ experience in related field preferred

Experience:

• At least 1 year experience in related field required
• Knowledge of insurance authorization, ICD-10 codes, CMS regulations, guidelines highly desired

Additional Job Description

MUSC Health Florence Medical Center is a leading regional acute care facility comprised of 396 patient beds and more than 1,500 employees and nearly 300 physicians representing all major specialties. We are dedicated to serving the health care needs of people living in northeastern South Carolina.
MUSC Health Florence Medical Center combines advanced technology, medical innovation and proven treatment methods to benefit of our patients. Our extensive range of services include heart and vascular care, cancer treatment, minimally invasive orthopedic and general surgery, diagnostics, women’s health and rehabilitation services.

When unexpected medical situations arise, our Emergency Department (ED/ER) is ready to respond. The hospital’s Chest Pain Center is the first in the region to have been accredited by the Society of Cardiovascular Patient Care (SCPC). MUSC Health Florence Medical Center’s advanced Primary Stroke Center, recognized by The Joint Commission, shows the hospital’s commitment to the highest standards in the country for stroke care.

About Florence, SC: “Florence, South Carolina, is a city that blends a fascinating history with a vibrant present. From its humble beginnings as a railroad town to its thriving arts scene and diverse economy, Florence has become a destination that offers something for everyone. Whether you're interested in history, culture, or outdoor activities, Florence is sure to captivate your heart and leave you wanting to explore more.” (quote from hollymelody.com). For more information, please visit About Florence – Greater Florence Chamber of Commerce (flochamber.com)

Benefits:
MUSC is a state facility, therefore our full-time positions come with the option of the State of South Carolina health and retirement benefits.

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees