DME/PRE-CERT SPECIALIST

Job Description

Job Description

Job Title:

DME Pre-Cert Specialist

Full Time/PRN:

Full Time

Job Summary

The Pre-Cert Specialist is responsible for coordinating all sleep study intake, authorization, scheduling, and patient preparation processes. This role ensures accurate documentation, insurance verification, prior authorization, patient financial responsibility coordination, and communication with providers, patients, and internal teams to support efficient sleep study operations.

Essential Duties & Responsibilities

Complete intake and review of referrals and orders for sleep studies; Ensure required documentation is in EMR; Verify insurance eligibility; Create encounters and financial numbers; Request and monitor prior authorizations; Communicate with providers regarding denials; Document pre-cert approvals and patient financial responsibility; Schedule sleep studies (in-facility and HSAT); Notify RT for order initiation; Complete pre-registration and admissions; Collect or arrange for patient payments; Provide necessary documentation to staff; Mail reminder letters; Provide paperwork for HSAT patients; Monitor systems (G3, Airview) for reports; Validate completeness of reports; Ensure reports are uploaded to EMR; Notify RT for order validation; Communicate issues with providers; Coordinate special scheduling needs; Communicate patient needs and logistics with team members; Provide reports when requested; Coordinate with biller for billing compliance.

Minimum Qualifications

High School Diploma or equivalent required; 2+ years with healthcare registration, scheduling, or insurance verification preferred; Knowledge of EMR systems such as Cerner preferred; Strong communication and organizational skills; Ability to manage multiple workflows simultaneously.

Working Conditions

Primarily office-based with frequent phone and computer use; High interaction with patients, providers, and staff; Requires attention to detail and ability to manage high-volume scheduling and coordination tasks.

All candidates must be able to perform the essential functions of this position. The American with Disabilities Act (ADA) requires that reasonable accommodations be made for qualified individuals to help perform the essential functions of the position.