Precertification/Authorization Specialist
MUSC Health
Summary
Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services.
Job description
Job Description Summary
Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services.
Job Description
Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care, via phone, fax, or payer websites. The Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. Other duties as assigned.
Requirements
- High School Degree or Equivalent
- 1 year of work experience
Benefits
- Health, Dental & Vision Insurance
- Life Insurance
- Employer Sponsored Retirement Plan
- Paid Time Off
- Extended Sick Leave
- Paid Parental Leave
- Disability Insurance
- Professional & Clinical Training
- Competitive Pay
- Annual Merit Increase
- Wellbeing Resources
- Tuition Reimbursement
- Employee Perks & Discounts
- Employee Referral Program
- Flexible Schedule Options
- Certification Incentive Program
Company overview
MUSC Health is the healthcare system of the Medical University of South Carolina, serving as the state's premier academic medical center and comprehensive healthcare provider. Founded in 1824 and headquartered in Charleston, South Carolina, MUSC Health operates 14 hospitals with approximately 2,500 beds and has five additional hospital locations in development. The organization provides patient care through more than 350 telehealth sites and nearly 750 care locations across all regions of South Carolina, serving 46 counties throughout the state. For 11 consecutive years, U.S. News & World Report has ranked MUSC Health as the number one hospital in South Carolina, reflecting its commitment to clinical excellence and patient safety. As an integrated academic health system, MUSC Health combines clinical care with medical education and research, training more than 900 residents and fellows annually while conducting groundbreaking research with $360 million in research funding and 1,268 active clinical trials. The organization employs over 10,000 team members and handles approximately 3.21 million patient encounters each year, delivering specialized services in cancer care, cardiac services, digestive health, women's health, and numerous other medical specialties through its Hollings Cancer Center and other specialized institutes.