Pre-Certification Coordinator

Job Description

Job Description

Job Description

Job Title:  Pre-Certification Coordinator

Department:  Revenue Cycle - Billing

Reports To:  Revenue Cycle Manager

FLSA Status:  Non-Exempt

Approval Date:  June 17, 2026

Summary

The Pre-Certification Coordinator supports the operational and authorization functions of the Revenue Cycle department. This role is responsible for obtaining prior authorizations, verifying insurance benefits, coordinating payer requirements, and maintaining accurate documentation to ensure timely reimbursement and continuity of patient care. The Coordinator partners with patients, providers, insurance carriers, and internal departments to ensure efficient workflows, regulatory compliance, and accurate claim processing.

Essential Duties and Responsibilities

• Obtain and verify prior authorizations, precertifications, and treatment approvals for medical consultations, procedures, diagnostic testing, and elective services.
• Verify insurance eligibility, benefits, provider participation status, coordination of benefits, and coverage requirements prior to service delivery.
• Review payer requirements and analyze insurance information to determine authorization and reimbursement requirements.
• Ensure all authorization requests are submitted accurately and within established departmental turnaround times.
• Communicate authorization status updates, approvals, denials, and pending requests to clinical teams and appropriate departments in a timely manner.
• Maintain accurate documentation of authorization activities, payer communications, and supporting records within the practice management system.
• Monitor pending authorization requests and perform follow-up with insurance carriers to minimize delays in patient care and reimbursement.
• Research and resolve authorization-related issues, documentation discrepancies, and payer inquiries.
• Collaborate with Scheduling, Clinical, Billing, Front Desk, and Revenue Cycle teams to resolve workflow issues and improve operational efficiency.
• Ensure compliance with HIPAA, CMS guidelines, payer regulations, and organizational policies and procedures.
• Participate in departmental meetings, audits, training activities, and process improvement initiatives as assigned.
• Other duties as assigned.

Qualifications

• High school diploma or equivalent required; Associate’s degree preferred.
• Minimum 3 years of healthcare, medical office, insurance verification, authorization, or revenue cycle experience required.
• Knowledge of ICD-10, CPT, HCPCS coding, insurance authorization processes, coordination of benefits, and healthcare reimbursement practices preferred.
• Experience with Athena, electronic medical records, Microsoft Word, Excel, PowerPoint, and healthcare practice management systems preferred.
• Strong organizational, analytical, communication, customer service, and problem-solving skills.
• Ability to manage multiple priorities in a fast-paced environment while maintaining attention to detail and operational accuracy.

Supervisory Responsibilities

This job has no supervisory responsibilities.

Certificates, Licenses, Registrations

None required.

Physical Demands & Work Environment

Primarily office-based role requiring prolonged computer use, regular communication, and the ability to manage multiple priorities in a fast-paced environment. Occasional lifting up to 30 pounds may be required.

Peachtree Orthopedics is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.