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.
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