Precertification Specialist

Liver Institute, Pllc in Tucson, AZ is looking for one precertification specialist to join our 21 people strong team. We are located at 5295 East Knight Dr. Our ideal candidate is attentive, motivated, and reliable. The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers.

Responsibilities

Review chart documentation to ensure patient meets medical policy guidelines
Prioritize incoming authorization requests according to the urgency
Obtain authorization via the payer website or by phone and follow up regularly on pending cases
Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
Initiate appeals for denied authorizations
Respond to clinic questions regarding payer medical policy guidelines
Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
Contact patients to discuss authorization status
Schedule patient appointments after precertification
Confirm appointments two days before procedure day.
Work with st joseph and st mary's hospital to schedule procedures for providers
Other duties as assigned
Qualifications

Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle
Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
Basic understanding of human anatomy
Proficient use of CPT and ICD-10 codes
Excellent computer skills including Excel, Word, and Internet use and SharePoint
Detail-oriented with above-average organizational skills
Plans and prioritizes to meet deadlines
Excellent customer service skills; communicates clearly and effectively
Ability to multitask and remain focused while managing a high-volume, time-sensitive workload