Job Overview
The Pre-Certification Specialist is responsible for obtaining prior authorizations and pre-certifications from insurance companies before medical services are rendered. This role ensures services are approved, verifies coverage, and helps prevent claim denials by confirming payer requirements in advance.
Duties
- Obtain prior authorizations and pre-certifications from insurance carriers for scheduled procedures, treatments, and services
- Review patient information, medical records, and physician orders to ensure accuracy and completeness
- Verify insurance eligibility benefits , and coverage details
- Communicate with insurance companies via phone, online portals, or fax to secure approvals
- Ensure all required clinical documentation is submitted to support authorization requests
- Track Authorization status and follow up on pending requests
- Document authorization numbers, approval details, and expiration dates in patient records or EHR systems
- Notify clinical staff and scheduling teams of authorization approvals or denials
- Assist in appeals for denied authoriztions when necessary
- Stay current on payer guidelines, insurance requirements, and policy changes
- Maintain confidentiality and comply with HIPAA regulations
Qualifications
- High school diploma or equivalent (Associate's or Bachelor's degree preferred)
- 1-3 years of experience in healthcare, insurance verification, or medical billing
- Knowledge of medical terminology, CPT/ICD codes, and insurance processes
- Experience working with electronic health records (EHR) systems
- Strong attention to detail and organization skills
- Excellent communication and customer service skills
- Ability to manage multiple tasks and prioritize workload effectively
Preferred Skills
- Experience with prior authorization workflows
- Familiarity with Medicare, Medicaid, and commerical insurance plans
- Problem-solving and analytical skills
- Proficiency in Microsoft Office and healthcare software
Work Environment
- Typically works in a healthcare setting such as a hospital, clinic, or physician's office
- May involve frequent phone and computer work
- Fast-paced environment with deadlines tied to patient scheduling
Pay: $16.00 - $19.00 per hour
Benefits:
- 403(b)
- 403(b) matching
- Dental insurance
- Disability insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
