Precertification Specialist

Semmes Murphey Clinic's mission is to deliver the best care for people suffering from neurological illness while advancing the field of neuroscience. 

Our precertification department is hiring a specialist. This role will primarily work on surgery precertification's. You will work closely with your team and the clinical staff to ensure the timely and efficient pre-cert of SMC procedures or surgeries and assist in providing continuity of quality patient care. 

Key Responsibilities: 

• Develop and maintain effective relationships with insurance companies, physicians, and medical office staff
• Determine necessity for precertification and coordinate with insurance companies, patients and clinical staff to obtain information
• Obtain and complete all insurance pre-certifications and authorizations, as required, for various surgical procedures
• Work collaboratively with block precertification and radiology precertification staff; contribute to both block and radiology authorizations as delegated
• Maintain complete and accurate precertification documentation in patient charts
• Regular and reliable attendance is required to successfully perform these essential functions

Minimum:

• High school diploma or equivalent
• Two (2) years’ relevant experience in medical registration/admissions, precertification and/or medical insurance

Preferred: 

• Current medical assistant certification or state licensure as a Practical Nurse (or licensure from a state within the Nursing Compact)

Knowledge, Skills, & Abilities 

• Proficient knowledge of insurance requirements, medical/clinical terminology, medical necessity associated with various clinical procedure codes, and certification/referral work flow
• Proficient in Microsoft Office (Excel, Outlook, Word)
• Knowledge of internet software and electronic medical records (EMR)
• Effective communication, both oral and written
• Excellent interpersonal skills with the ability to tactfully interact with all levels of the organization 
• Ability to provide excellent customer service during difficult or emotional situations
• Ability to manage workflow and prioritize demands 
• High level of confidentiality and discretion

Equal Opportunity Employer/Veterans/Disabled  

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