Precertification Specialist
AUGUSTA ORTHPEDIC AND SPORTS MEDICINE SPECIALIST
Augusta, GA
03.2022 - Current
- Answered telephones and directed calls to appropriate medical or adminstrative staff.
- Processed appeals when necessary following denial or rejection of claims due to lack of proper authorization.
- Provided follow-up on pending precertification requests to ensure timely processing.
- Assisted with answering provider inquiries regarding preauthorization requirements and processes.
- Monitored office supplies inventory and placed orders when necessary.
- Compiled and submitted precertification requests for review by payers in accordance with established timelines.
- Completed relevant insurance and other claim forms.
- Reviewed applications to verify client information and resolve discrepancies.
- Collaborated with medical scientists to prepare reports, articles or conference presentations.
- Compiled and coded patient information or data in appropriate computer system.
- Generated reports summarizing key metrics related to the performance of the precertification team.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Verified insurance eligibility, coverage levels, and benefit parameters prior to submission of precertification requests.
- Researched current payer policies related to specific services or diagnoses as needed.