Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Precertification Specialist

$26 per hour

The Emerson Group

Precertification Specialist

Our award-winning medical practice client in Philadelphia is looking for a Precertification Specialist to join their team. The ideal candidate will have at least 1 year of experience with precertification. Candidates must have a good work history and are extremely detail oriented. The hours are 7am-5pm Mondays-Thursdays. Parking pass is also included. This is a Direct Hire position with hourly rate up to $26/hour with excellent benefits.

The Precertification Specialist is responsible for managing and processing prior authorization requests for biologic medications, ensuring timely and accurate approvals in compliance with payer guidelines and clinical protocols. This role requires a strong understanding of biologic therapies, insurance requirements, and healthcare workflows. The specialist works closely with Billing Director, providers, patients, insurance companies, and pharmacy teams to facilitate access to high-cost biologic treatments. Attention to detail, excellent communication skills, and the ability to navigate complex payer systems are essential.

Key Responsibilities:

  • Submit and track prior authorization requests for biologic medications.
  • Verify insurance benefits and eligibility for specialty therapies.
  • Collaborate with providers to obtain necessary clinical documentation.
  • Communicate with payers to resolve issues and expedite approvals.
  • Educate patients on authorization status and next steps.
  • Maintain accurate records in payer portals.
  • Stay updated on payer policies and biologic drug changes.
  • Enroll patients in co-pay assistance programs.
  • Enter Biologic Charges.
  • Run Monthly Reports
  • Follow-up on denied biologic claims.
  • Non-biologic billing tasks as needed.

Key Performance Metrics:

  • Authorization Turnaround Time: Average time from submission to approval.
  • Approval Rate: Percentage of biologic precertifications approved on first submission.
  • Denial Resolution Rate: Success rate of overturned denials through appeals.
  • Documentation Accuracy: Percentage of submissions with complete and correct documentation.
  • Patient Communication Timeliness: Time taken to notify patients of authorization status.
  • Compliance Rate: Adherence to payer-specific guidelines and internal protocols.
  • Volume Management: Number of precertification cases handled per week/month.

Qualifications:

  • Experience in precertification or prior authorization
  • Knowledge of commercial insurance plans.
  • Familiarity with specialty pharmacy workflows and biologic drug therapies.
  • Strong organizational and communication skills.
  • Proficiency in payer portals.
  • Ability to work independently and collaboratively.
Vacancy posted 19 days ago
Similar jobs that could be interesting for youBased on the Precertification Specialist in Philadelphia, PA vacancy
  • $26 per hour

     ...Our award-winning medical practice client in Philadelphia is looking for a Precertification Specialist to join their team. The ideal candidate will have at least 1 year of experience with precertification. Candidates must have a good work history and are extremely detail... 
    Suggested
    Hourly pay

    Emerson Group

    Philadelphia, PA
    3 days ago
  •  ...Pre-Cert Specialist Bring your drive for excellence, team orientation and customer commitment to Independence Blue Cross; help...  ...licensed health professionals, the Pre-Cert Specialist processes precertification requests in accordance with established corporate guidelines... 
    Suggested
    Remote job
    Work at office

    Independence Blue Cross

    Philadelphia, PA
    1 day ago
  •  ...Preregistration Specialist- Dermatology Penn Medicine is dedicated to our tripartite mission of providing the highest level of...  ...responsible for insurance verification, benefit obtainment, and precertification for all HUP scheduled outpatient surgical procedures and... 
    Suggested
    Full time
    Work experience placement

    Pennsylvania Medicine

    Philadelphia, PA
    1 day ago
  •  ...employees shape our future each day. Job Title Preregistration Specialist Department Financial Clearance Location WFH Remote -...  ...responsible for insurance verification, benefit obtainment, and precertification for all HUP scheduled outpatient surgical procedures and... 
    Suggested
    Work at office
    Remote work
    Work from home

    Penn Medicine

    Bala Cynwyd, PA
    3 days ago
  •  ...Complaint Analysts/ Complaint Specialist/ Complaint Coordinator A Few Words About Us Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent... 
    Suggested
    Immediate start

    Careers Integrated Resources Inc

    Horsham, PA
    4 days ago
  •  ...Vitreoretinal Surgery - Retina Specialist Position Full-time retina position with Prism Vision Group - NJ Retina in Monroe, NJ, New Brunswick, NJ and Lawrenceville, NJ. Meet Our Team | Ophthalmologists | Retina Specialist Doctors. Current openings with several different... 
    Full time
    Private practice
    Relocation package

    PRISM Vision Group

    Moorestown, NJ
    2 days ago
  •  ...The job of Orientation and Mobility Specialist was established for the purpose/s of assist special education students age birth to 21, with visual and or other impairments to achieve maximum independence through safe, efficient travel within the home, school, and community... 
    Temporary work

    Delaware County Intermediate Unit

    Morton, PA
    2 days ago
  •  ...At Kulicke and Soffa we prioritize a culture of growth, flexibility, and diversity. As a senior specialist, Global Compensation and Benefits, you will play a critical role in shaping our team and supporting our mission to lead technological innovation to enable a smart... 
    Local area
    Shift work

    Kulicke & Soffa

    Fort Washington, PA
    2 days ago
  • $111.5k - $223k

    We are seeking a talented individual to join our Strategic Bid Center at Mercer. This role will be remote and work from anywhere in the US. The role would involve managing live pursuit deliverables across Mercer's practices, with a focus on health and career proposals...
    Minimum wage
    Remote work
    Flexible hours

    Mercer

    Philadelphia, PA
    4 days ago
  • $18.65 - $19.9 per hour

     ...at Tower - St. Christopher's Hospital in Philadelphia, PA * We are seeking a Medical Records/Health Information Management Specialist . Job Responsibilities: Completes analysis/reanalysis of all records accurately and timely Completes accounts from... 
    Full time
    Local area
    Remote work

    Ensemble Health Partners

    Philadelphia, PA
    10 hours ago
  • Job Title Serves as the single point of contact to internal and external customers to ensure easy and seamless access to physicians, employees, patients, programs and services. Handles complex scheduling requests through various channels while utilizing numerous protocols...
    Work at office

    Temple Health

    Philadelphia, PA
    5 days ago
  •  ...vision to inspire people through golf and tennis.**Position Summary**Reporting to the Sales and Service Manager, a STUDIO Fitting Specialist is responsible for engaging with every customer to provide world-class service, building lasting relationships that encourage... 
    Hourly pay
    Work at office
    Flexible hours
    Night shift

    PGA TOUR Superstore

    Cherry Hill, NJ
    23 hours ago
  •  ...Reimbursement Location : 3535 Market Street, Suite 1400 Hours : Hybrid, M-F, 8:30AM to 5:00PM Summary: The Reimbursement Specialist will provide reimbursement and financial support to both corporate and hospital leadership in an efficient and customer-focused... 
    Interim role
    Work at office

    Penn Medicine

    Philadelphia, PA
    2 days ago
  • Responsibilities Complete processing and review to ensure commission payments for internal and external producers are prepared accurately and generated in accordance with established policies and procedures. Advise, verify, and approve work items of team members as a Subject...

    Maguire Insurance Agency Inc

    Bala Cynwyd, PA
    1 day ago
  •  ...Commissions Specialist Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are... 
    Work at office

    Philadelphia Insurance Companies

    Bala Cynwyd, PA
    1 day ago
  •  ...Intraoperative Neuromonitoring Specialist I (PRN) Job ID: 314740 Category: Technician/Technologists Work Type: PER DIEM Location: Philadelphia, PA, United States Work Schedule: Per Diem Penn Medicine is dedicated to our tripartite mission of providing the highest... 
    Daily paid
    Relief
    Immediate start
    Night shift
    Weekend work

    Pennsylvania Medicine

    Philadelphia, PA
    1 day ago
  •  ...Compression Specialist medi USA is growing, and we need you to join the team i n Philadelphia, PA medi is a market leader in medical devices and is looking for folks ready to operate in a professional environment to service medi's USA's expanding business needs... 
    Temporary work
    Work at office
    Local area

    medi USA

    Philadelphia, PA
    1 day ago
  • $35 - $100 per hour

    Macroeconomic Modeling Specialist (EViews) - $35-$100/hour Job Title: Macroeconomic Modeling Specialist (EViews) Job Type: Contract Location: Remote Job Summary Join our customer's team as a Macroeconomic Modeling Specialist (EViews) and drive the creation, validation... 
    Remote job
    Contract work

    Micro1

    Gloucester City, NJ
    10 hours ago
  • A healthcare organization is seeking an Entry Level Radiology Image Library Associate for the 8am-4pm shift in Abington Township. This role involves important patient interactions and requires skills in managing medical records and communication with healthcare providers...
    Shift work

    Jobologi, Inc.

    Abington, PA
    2 days ago
  • $124.74k - $254.5k

     ...find new areas of inspiration and expand your capabilities, then consider a career in Advisory. KPMG is currently seeking a Lead Specialist, AI Solution Architect to join our KPMG Managed Services practice. Responsibilities: Architect and lead end-to-end... 
    H1b
    Local area

    KPMG

    Philadelphia, PA
    10 hours ago
  •  ...Housing Program Specialist The mission of the U.S. Department of Housing and Urban Development is to foster strong communities by supporting access to quality, affordable housing, expanding the housing supply, and unlocking homeownership opportunities for the American... 
    Work at office

    U.S. Department of Housing and Urban Development

    Philadelphia, PA
    3 days ago
  • $18 - $23 per hour

     ...Shine on as a Behavior Support Specialist. Specialized Education Services, Inc. (SESI), a division of FullBloom, is a premier provider of education services for K-12 students who require additional supports to overcome challenges that impede success in a traditional... 

    Specialized Education Services, Inc.

    Philadelphia, PA
    10 hours ago
  •  ...Route Coverage Specialist - UniFirst At UniFirst, we Always Deliverfor our customers and our people. Join us as a Route Coverage Specialist, a key service professional integral to the success of our operations. In this role, you'll provide exceptional service by stepping... 
    Work at office
    Local area
    Day shift

    UniFirst

    Gladwyne, PA
    4 days ago
  • $44k - $49k

     ...Housing Specialist Action Wellness started as ActionAIDS in 1986 when a group of dedicated volunteers came together to support their community at the beginning of the HIV epidemic. Today, staff provide a range of trauma-informed services to help persons with HIV and... 
    Permanent employment
    Full time
    Work at office
    Local area
    Remote work

    Action Wellness Inc

    Philadelphia, PA
    10 hours ago
  • $19 per hour

     ...Plan Join us and be a part of something bigger. Apply today. Job Description Elwyn seeks a Psychiatric Rehabilitation Specialist to provide individualized supports and skill development to individuals in the community. Promote personally meaningful connections... 
    Hourly pay
    Work experience placement
    Local area
    Flexible hours
    Weekend work
    Afternoon shift

    Elwyn

    Upper Darby, PA
    2 days ago
  •  ...Quality Location: 1500 Market Street; travel required throughout Philadelphia Job Overview: The Outreach and Engagement Specialist (OES) is responsible for representing Health Promotion Services (HPS) and Health Promotion Council (HPC) at community events. The... 
    Part time
    Flexible hours
    Afternoon shift

    PHMC

    Philadelphia, PA
    10 hours ago
  • $48 - $53 per hour

     ...Health Informatics Specialist III (Remote) Pride Health is hiring a Health Informatics Specialist III for one of its clients in Pennsylvania. This is a 12-month contract with a possible extension, with competitive pay and benefits. The position is fully remote. Job Title... 
    Contract work
    Local area
    Remote work
    Monday to Friday
    Shift work

    PRIDE Health

    Philadelphia, PA
    4 days ago
  •  ...Supportive Behavioral Resources, Inc, (SBR) is hiring for Part-Time Behavior Specialists to support the positive, emotional, and behavioral growth of adults with Intellectual/Developmental Disabilities and Autism. Requirements: Availability to work at least 10... 
    Part time
    10 hours per week

    SBR LLC

    Philadelphia, PA
    2 days ago
  •  ...Certified Recovery Specialist The Certified Recovery Specialist will provide direct care to patients who are managing addictive disease disorders, chemical dependency problems, psychiatric disorders and other illnesses. The Certified Recovery Specialist, working under... 
    Monday to Friday

    Kirkbride Center

    Philadelphia, PA
    2 days ago
  •  ...We are seeking a full-time Mental Health Specialist to work in our Behavioral Health Services Division, to assist in the delivery of treatment, rehabilitation and support services. The Mental Health Professional provides clinical supervision in assessment and treatment... 
    Full time
    Internship
    Live in
    Local area
    Immediate start

    Horizon House

    Philadelphia, PA
    4 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Precertification Specialist. Be the first to apply!