Top 1 Precertification specialist surgery Jobs in Pennington, Nj

Precertification Specialist - Surgery
Delaware Valley Management —Newtown, PA
- Full-time
- Surgery
- Mid-level
- Neurology
Quick Apply

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Precertification Specialist - Surgery

Delaware Valley Management
Newtown, PA

Quick Apply

Job Details

Full-time

Qualifications

Customer communication

Full Job Description

Surgical Precertification Specialist
Full-Time – Remote

MUST LIVE IN NJ, PA OR FL

Position Summary
This role handles the end-to-end authorization process for commercial insurance carriers to make sure surgical cases get approved correctly, cleanly, and on time. The specialist works closely with surgeons, schedulers, patients, and insurance reps to keep cases moving and prevent last-minute surprises.

Key Responsibilities

Review surgery requests for accuracy, completeness, and medical necessity documentation
Submit prior authorization requests to payers; track and follow up until determination
Communicate case status to surgeons, schedulers, clinical staff, and patients
Verify benefits insurance is active to obtain authorization
Request and collect clinical records, imaging reports, and supporting documentation
Handle peer-to-peer requests, denials, and appeals coordination
Maintain organized case logs and meet turnaround time expectations
Identify payer quirks, trends, and requirements to prevent delays

Maintain flexibility within the role to deliver the best possible patient care
- Work collaboratively with the rest of the precertification team to keep workflows tight and predictable
- Provide excellent customer service

Qualifications

MUST live in NJ, PA or FL

MUST HAVE Experience with precertification or prior authorization for surgical services
- Neuro/Spine/Ortho/Pain Management surgery experience preferred but not required
- Strong understanding of medical terminology, CPT/ICD-10 codes, and clinical documentation
- Comfort working with EMRs, payer portals, Microsoft and Adobe
- Solid communication skills — clear, direct, and calm
- Ability to juggle multiple cases without losing track
- Detail-oriented with good judgement on what needs escalation and what just needs another phone call
- High level of reliability and follow-through

Quick Apply

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precertification specialist surgery jobs in pennington, nj

Precertification Specialist - Surgery

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