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
  •  ...Preregistration Specialist Financial Clearance Penn Medicine is dedicated to our tripartite mission of providing the highest level...  ...for insurance verification, benefit obtainment, and precertification for all HUP scheduled outpatient surgical procedures and inpatient... 
    Suggested
    Work at office
    Remote work
    Work from home

    Pennsylvania Medicine

    Bala Cynwyd, PA
    2 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
  • $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
  •  ...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
  •  ...Job Description INVO , a proud member of The Stepping Stones Group, is seeking a dynamic, full-time Orientation & Mobility Specialist to join our growing team in Philadelphia, PA . Through our revolutionary IMPACT program model, we provide students with Adverse... 
    Full time
    Relocation package

    The Stepping Stones Group, LLC

    Philadelphia, PA
    8 hours ago
  • $59.95k - $68.68k

     ...Delaware County Intermediate Unit - Morton, Pennsylvania Orientation and Mobility Specialist Job ID: 5724182 Application Deadline: Posted until filled Posted: May 19, 2026 4:00 AM (UTC) Starting Date: Immediately Job Description The job of Orientation and Mobility Specialist... 
    Full time
    Temporary work
    Immediate start

    Young World Physical Education

    Morton, PA
    3 days 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
  • $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
    13 hours 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
  • 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
  •  ...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 repeat... 
    Hourly pay
    Work at office
    Flexible hours
    Night shift

    Twice

    Plymouth Meeting, PA
    3 days ago
  • $60k - $112k

     ...end technology solutions connecting the space, air, land, sea and cyber domains in the interest of national security. Job Title: Specialist, Production Planning Job Code: 37135 Job Location: Camden, NJ Schedule: 9/80 – Employees work 9 out of every 14 days, totaling 80... 
    Local area
    Flexible hours

    L3Harris Technologies

    Camden, NJ
    2 days 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
  •  ...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
  • 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
  •  ...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
  • $18 - $20 per hour

     ...General Description Under direction of the Community Manager, the Leasing Specialist is responsible for assisting in all operations of the leasing office. The Leasing Specialist should work to minimize vacancy, quickly lease apartments, meet all occupancy goals, promote... 
    Hourly pay
    Full time
    Temporary work
    Work at office
    Local area
    Immediate start
    Monday to Friday
    Flexible hours
    Afternoon shift

    Conifer Realty

    Camden, NJ
    13 hours ago
  • $18 - $20 per hour

    Compensation Range: $18.00 to $20.00 Hourly Location: 2101 Rte 130 S, Cinnaminson, New Jersey 08077 United States of America Are you ready to rev up your career? U-Haul is looking for new team members to clean and detail the newest trucks and trailer fleet in the...
    Hourly pay
    Local area

    U-Haul

    Riverton, NJ
    4 days 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
    13 hours 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
    13 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
  • $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
    13 hours ago
  •  ...Certified Recovery Specialist We offer competitive salary, full benefits package, Paid Time Off, and opportunities for professional growth. Pinnacle Treatment Centers is a growing leader in addiction treatment services. We provide care across the nation touching... 
    Full time
    Temporary work

    Pinnacle Treatment Centers

    Lansdowne, PA
    2 days ago
  •  ...individuals in accessing resources related to creating Housing Stability***** We are seeking qualified candidates for the Housing Specialist position to work with our Intensive Care Case Management (ICCM) team in Philadelphia, PA. This position assists participants... 
    Local area

    Horizon House

    Philadelphia, PA
    3 days ago
  • $20.52 - $22.58 per hour

     ...Crisis Intervention Specialist Join our team today and immerse yourself in a rewarding career for years to come! As a Crisis Intervention Specialist/Screener, you will work within our Crisis Screening program located in Cherry Hill, Camden County. The Camden County... 
    Hourly pay
    Flexible hours

    Oaks Integrated Care

    Cherry Hill, NJ
    1 day ago

Do you want to receive more vacancies?

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