Preauthorization/Precertification Specialist - Oncology/Infusion Services

Position Overview

MedStar Health is actively recruiting for a Preauthorization / Precertification Specialist to join our Patient Financial Services team. This role is responsible for managing the financial and authorization processes involved in oncology and infusion treatments while providing assistance to patients and providers by confirming and completing required pre-certifications/authorizations prior to service.

Compensation: $18.33 - $31.61

Key Responsibilities

• Verifies eligibility and conformance to departmental and managed care requirements; obtains insurance referrals and pre-authorizations; submits referral information and assists with pre-authorizations for scheduled procedures including hospital admissions, procedures, medications, and medical equipment.
• Reviews scheduled procedures to initiate authorization and pre-certification activities, confirms correct insurance information, and ensures completeness through cross-referencing documentation.
• Maintains ongoing communication with insurance companies to determine benefit eligibility, deductible status, and obtains pre-certifications; promptly addresses inquiries from providers, hospital staff, and patients.
• Ensures accurate entry of relevant data into the IDX and SMS/Invision systems by linking data to appointments for proper billing; obtains and records missing pre-certification or authorization numbers and coordinates rescheduling if required.
• Monitors and completes the MedConnect Pre-Authorization Work Queue with accurate status updates, liaising with provider staff for any additional documentation or Peer-to-Peer requests.
• Maintains daily performance benchmarks, adheres to departmental Quality Assurance standards, and stays current with regulatory changes related to pre-authorization and pre-certification.

Required Qualifications

• High School Diploma or GED required.
• 1-2 years experience in patient accounting, patient access, or pre-arrival services, or an equivalent combination of experience and college education in accounting, finance, or healthcare administration.
• Working knowledge and demonstrated proficiency in payer authorization and clearance processes.
• Basic working knowledge of UB04, HCFA 1500 (or equivalent) and payer responses.
• Familiarity with medical terminology and CPT/ICD-9/10 coding.
• Excellent communication, analytical, interpersonal, and organizational skills.
• Proficiency in hospital registration/billing systems, Microsoft Excel and Word applications, and general computer use.
• Ability to type at least 35 WPM.