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Join to apply for the Precertification Specialist - Mon-Fri 8A-4:30P (Full-Time) role at Washington Regional1 week ago Be among the first 25 applicantsJoin to apply for the Precertification Specialist - Mon-Fri 8A-4:30P (Full-Time) role at Washington RegionalOrganization Overview, Mission, Vision, And ValuesOur mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for four consecutive years by U.S. News & World Report. We employ 3,400+ team members and serve the region with over 45 clinic locations, the area's only Level II trauma center, and five Centers of Excellence - the Washington Regional J.B. Hunt Transport Services Neuroscience Institute; Washington Regional Walker Heart Institute; Washington Regional Women and Infants Center; Washington Regional Total Joint Center; and Washington Regional Pat Walker Center for Seniors.Position SummaryThe role of the Pre-Certification Specialist reports to the Scheduling Manager. This position is responsible for utilizing the electronic medical record system to abstract information to prove medical necessity to the payor and to ensure precertification for services is obtained prior to the date of service. This position is responsible for researching resolutions for authorization issues and recommends process improvement to reduce denials associated with authorizations.Essential Position ResponsibilitiesEffectively communicate with the ordering providers and/or necessary clinic staff for medical reviews and preauthorization regarding future casesMaintain a current working knowledge of authorization and medical necessity requirementsReview cases for anticipated denials and schedules peer reviewsUtilize the appropriate system to document the case outcomeAssist the scheduling and admissions staff with inquiries regarding medical necessity and authorizationsCollaborate with necessary departments/providers to ensure overall accuracy of authorizationsComplete post procedure reviews to initiate updates to existing authorizationsMay be assigned specific insurance plans and provider specialties but expected to learn on the job other insurances and specialties.QualificationsEducation: High School Diploma or GEDLicensure/Certifications: N/AExperience: Minimum of two years' experience in a medical setting with a focus in coding, admitting, or precertification, preferred. Previous experience with CPT and ICD 10 codes, preferred.Work Environment: This position will spend 80% of time standing and/or walking while pushing, pulling, lifting, and/or carrying up to 50 lbs. This position will spend 20% of time sitting while performing work in a standard office environment. This position will serve a culturally and linguistically diverse patient population.Seniority level Seniority level Entry levelEmployment type Employment type Full-timeJob function Job function OtherIndustries Hospitals and Health CareReferrals increase your chances of interviewing at Washington Regional by 2xGet notified about new Specialist jobs in Fayetteville, AR .Fayetteville, AR $49,500.00-$71,500.00 1 month agoFayetteville, AR $31,061.33-$39,936.00 1 month agoFayetteville, AR $102,890.67-$139,637.34 1 month agoFayetteville, AR $39,936.00-$57,685.00 1 month agoFayetteville, AR $78,624.00-$113,568.00 1 month agoFayetteville, AR $71,400.00-$96,900.00 1 month agoFayetteville, AR $54,357.33-$73,770.66 1 month agoFayetteville, AR $132,288.00-$191,082.67 1 month agoFayetteville, AR $102,890.67-$139,637.34 1 month agoFayetteville, AR $65,471.47-$88,854.14 1 month agoFayetteville, AR $74,741.33-$101,434.66 1 month agoInsurance Claims Analyst (Full-Time, M-F, Day Shift) Fayetteville, AR $132,288.00-$191,082.67 1 month agoFayetteville, AR $74,741.33-$101,434.66 1 month agoFayetteville, AR $69,888.00-$100,949.33 1 month agoIP CDI Specialist - Certified (Full-Time, Mon-Fri) Fayetteville, AR $91,800.00-$132,600.00 1 month agoCustomer Marketing Planning Analyst, Walmart Rogers, AR $77,800.00-$97,300.00 2 weeks agoWe're unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.#J-18808-Ljbffr