Medical University of South Carolina (MUSC)

Percertification/Authorization Specialist - Palmetto Park Blvd.

Posted 2 Days Ago

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Lexington, KY, USA

In-Office

Junior

Healthtech • Professional Services • Biotech • Pharmaceutical

The Role

Verifies patient eligibility and insurance benefits, identifies payer requirements, and obtains pre-certifications, authorizations, and referrals for inpatient, outpatient, and ancillary services. Communicates with payers and clinical partners by phone, fax, and payer websites, ensures compliance with contractual requirements, and documents authorization information in patient records.

Summary Generated by Built In

Job Description Summary

Job Description
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

MUSC Community Physicians (MCP)

Worker Type

Employee

Worker Sub-Type

Regular

Cost Center

CC001878 MCP - Columbia Heart Lexington

Pay Rate Type

Hourly

Pay Grade

Health-20

Scheduled Weekly Hours

Work Shift

Job Description

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.

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.

Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees

Skills Required

High school diploma or equivalent
At least 1 year of work experience

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The Company

HQ: Charleston, SC

25,000 Employees

Year Founded: 1824

What We Do

The Medical University of South Carolina (MUSC) is a public academic health system founded in 1824 and based in Charleston, South Carolina. MUSC combines patient care (MUSC Health), medical education, and biomedical research to advance health statewide and beyond. The institution trains health professionals, conducts translational research, and delivers comprehensive clinical services across South Carolina.