WMG Precertification Specialist l

Company: Wellstar Health System, Inc.
Location: Marietta
Posted on: March 12, 2023

Job Description:

Responsibilities

A WMG Pre-certification Specialist I is responsible for obtaining pre-certification/authorization for outpatient diagnostic procedures for practice and HOD visits and ensuring referrals are completed timely. The WMG Pre-certification Specialist I position reports directly to the WMG Central Precertification Manager.

Key responsibilities:
The WMG Pre-certification Specialist I function under the direction of the Manager of Centralized Precertification. Provides outstanding customer service to their dedicated physician practice. This position supports practice volumes and increasing revenues by obtaining Pre-Authorization for outpatient testing, outpatient diagnostic and medications in a timely manner while maintaining the required 3 day out ahead of the practice's schedule. Consistent review of payer authorization policies to ensure all procedures are authorized in a timely manner. Utilize various departmental tools and appropriate reports to identify and trend any on-going issues with payers and physician practice processes resulting in fatal denials. This position works with physicians, nurses, clinic managers and financial advocates to resolve issues that arise during the prior authorizations process. This position may also support Pre-Registration including preparing patient estimates. Maintain established productivity benchmarks and meets goals in a fast-paced environment. Other duties as assigned.

Impact of this role in the organization:
The WMG Pre-certification Specialist I impact to the organization improves Patient Experience and operational workflow in respect to Patient Access to services within WMG practices.

Qualifications

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Keywords: Wellstar Health System, Inc., Marietta , WMG Precertification Specialist l, Other , Marietta, Georgia