Precertification/Authorization Specialist

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. 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.

Entity

Medical University Hospital Authority (MUHA)

Worker Type

Employee

Worker Sub-Type​

Regular

Cost Center

CC003760 COL - Patient Access Services (DMC)

Pay Rate Type

Hourly

Pay Grade

Health-20

Scheduled Weekly Hours

40

Work Shift

Job Description

Entity/Organization:  MUHA (Medical University Hospital Authority/Medical Center)

Hours Per Week: 40

Scheduled Work Hours/Shift:  

FLSA Status: Hourly

Job Summary/Purpose:

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.

Minimum Training and Education:  High School Degree or Equivalent Work Experience: 1 year

Required Licensure, Certifications, Registrations: 

Physical Requirements: Ability to perform job functions while standing. (Frequent) Ability to perform job functions while sitting. (Frequent) Ability to perform job functions while walking. (Frequent) Ability to climb stairs. (Infrequent) Ability to work indoors. (Continuous) Ability to work from elevated areas. (Frequent) Ability to work in confined/cramped spaces. (Infrequent) Ability to perform job functions from kneeling positions. (Infrequent) Ability to bend at the waist. (Frequent) Ability to squat and perform job functions. (Infrequent) Ability to perform repetitive motions with hands/wrists/elbows and shoulders. (Frequent) Ability to reach in all directions. (Frequent) Possess good finger dexterity. (Continuous) Ability to fully use both legs. (Continuous) Ability to fully use both hands/arms. (Continuous) Ability to lift and carry 15 lbs. unassisted. (Infrequent) Ability to lift/lower objects 15 lbs. from/to floor from/to 36 inches unassisted. (Infrequent) Ability to lift from 36 inches to overhead 15 lbs. (Infrequent) Ability to maintain 20/40 vision, corrected, in one eye or with both eyes. (Continuous) Ability to see and recognize objects close at hand or at a distance. (Continuous) Ability to match or discriminate between colors. (Continuous) *(Selected Positions) Ability to determine distance/relationship between objects; depth perception. (Continuous) Ability to maintain hearing acuity, with correction. (Continuous) Ability to perform gross motor functions with frequent fine motor movements. (Continuous) Ability to work in a latex safe environment. (Continuous) *Ability to maintain tactile sensory functions. (Frequent) *(Selected Positions) *Ability to maintain good olfactory sensory function. (Frequent) *(Selected Positions) *Ability to be qualified physically for respirator use, initially and as required. (Continuous) (Selected Positions)* 

Additional Job Description

Education: High School Degree or Equivalent Work Experience: 1 year

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

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