Precertification Specialist - Surgery

Surgical Precertification Specialist
Full-Time - Remote

MUST LIVE IN NJ, PA OR FL

Position Summary
This role handles the end-to-end authorization process for commercial insurance carriers to make sure surgical cases get approved correctly, cleanly, and on time. The specialist works closely with surgeons, schedulers, patients, and insurance reps to keep cases moving and prevent last-minute surprises.

Key Responsibilities
• Review surgery requests for accuracy, completeness, and medical necessity documentation
• Submit prior authorization requests to payers; track and follow up until determination
• Communicate case status to surgeons, schedulers, clinical staff, and patients
• Verify benefits insurance is active to obtain authorization
• Request and collect clinical records, imaging reports, and supporting documentation
• Handle peer-to-peer requests, denials, and appeals coordination
• Maintain organized case logs and meet turnaround time expectations
• Identify payer quirks, trends, and requirements to prevent delays

• Maintain flexibility within the role to deliver the best possible patient care
  • Work collaboratively with the rest of the precertification team to keep workflows tight and predictable
  • Provide excellent customer service

Qualifications
• MUST live in NJ, PA or FL

• MUST HAVE Experience with precertification or prior authorization for surgical services
  • Neuro/Spine/Ortho/Pain Management surgery experience preferred but not required
  • Strong understanding of medical terminology, CPT/ICD-10 codes, and clinical documentation
  • Comfort working with EMRs, payer portals, Microsoft and Adobe
  • Solid communication skills - clear, direct, and calm
  • Ability to juggle multiple cases without losing track
  • Detail-oriented with good judgement on what needs escalation and what just needs another phone call
  • High level of reliability and follow-through