Precertification Specialist

Description

Columbia Orthopaedic Group

Helping patients get the care they need starts before they ever arrive. If you're someone who enjoys solving insurance puzzles, staying organized, and making sure every detail is in place before care begins, you'll thrive in this role.

Why This Role Is Different

The Precertification Specialist plays a vital role in ensuring patients receive timely care by securing insurance approvals before services are provided. Working behind the scenes, you'll partner with providers, clinical teams, and insurance companies to remove barriers and keep care moving forward.

This position combines problem-solving, communication, and attention to detail to support both an exceptional patient experience and a healthy revenue cycle.

About the Role

The Precertification Specialist is responsible for obtaining prior authorizations and precertifications for medical procedures, treatments, and services. This role helps ensure patients are financially and clinically prepared for care while minimizing authorization delays and insurance denials.

Success in this role requires strong organizational skills, knowledge of insurance processes, and the ability to manage multiple priorities in a fast-paced healthcare environment.

What You Will Do

• Submit, monitor, and follow up on prior authorization and precertification requests with insurance providers
• Verify patient insurance eligibility, benefits, and coverage requirements prior to scheduled services
• Review clinical documentation and collaborate with providers to ensure authorization requirements are met
• Communicate with patients, providers, and insurance companies regarding authorization status and resolve issues as they arise
• Research authorization denials, coordinate appeals when appropriate, and maintain accurate documentation within the electronic medical record (EMR)
• Partner with scheduling, billing, and clinical teams to support timely approvals and reduce delays in patient care

Who Thrives in This Role

• You enjoy solving problems and navigating complex insurance requirements
• You are highly organized and able to manage multiple deadlines simultaneously
• You communicate confidently with patients, providers, and insurance representatives
• You take pride in accuracy and understand how your work supports both patients and the organization

Requirements

• High school diploma or equivalent required
• Minimum of two (2) years of experience in precertification, insurance verification, or medical billing required
• Associate's or Bachelor's degree in a healthcare-related field, orthopaedic experience, or knowledge of CPT/ICD-10 coding preferred
• Experience with electronic medical record (EMR) systems and payer portals preferred