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Summary: The pre-certification specialist is responsible for obtaining prior authorizations for all procedural and ancillary orders by successfully completing the authorization process with all required payers.
Review chart documentation to ensure patient meets medical necessity guidelines
Prioritize incoming authorization requests according to urgency
Obtain authorization via payer website or by phone and follow up regularly on pending cases
Maintain current with payer requirements needed to successfully obtain authorizations
Initiate appeals for denied authorizations
Respond to clinic questions regarding payer medical necessity guidelines
Confirm accuracy of CPT and ICD-10 diagnoses in the procedure orders
Compensation & Benefits: Competitive wages and excellent fringe benefit program. Salary commensurate with experience.
Dedicated to being Simply the Best! Pratt Regional Medical Center provides excellent and compassionate healthcare. PRMC is a progressive medical center serving south central Kansas and the panhandle of Oklahoma. Come join us to be part of the excitement that is PRMC! We recently completed up a major building project which provides our employees a wonderful place to work. PRMC employs only the best people and with the building completion our staff will have the best of both worlds!