Pre-Certification Specialist

We are seeking a highly organized and detail-oriented Pre-Certification Specialist to join our healthcare team. In this role, you will be responsible for obtaining insurance authorizations and verifying patient benefits to ensure services are approved before treatment. This position serves as a liaison between patients, providers, and insurance carriers to ensure medical services meet payer requirements and are authorized before treatment. The specialist helps minimize claim denials, improve reimbursement, and support a positive patient experience.

The ideal candidate is knowledgeable in insurance processes, thrives in a fast-paced environment, and is committed to delivering exceptional support to patients and providers. We offer a competitive salary and benefits package, as well as opportunities for growth and advancement within our organization. Looking for a better work/life balance? Our career opportunities have Monday-Fridays work schedules. Competitive Pay & Benefits: Med/Dental/Vision, Paid Personal Time, Paid Holidays, 401K, Paid STD/LTD/Life.

What You Will be Doing:

• Verify patient insurance eligibility, benefits, and coverage.
• Obtain prior authorizations and pre-certifications for procedures, diagnostic testing and specialty services.
• Review physician orders and supporting clinical documentation for authorization requirements.
• Submit authorization requests and required medical records to insurance carriers.
• Monitor and track authorization approvals, denials, and expirations.
• Follow up on pending requests to ensure timely completion.
• Communicate authorization status and patient financial responsibility to providers, staff, and patients.
• Assist with appeals and reconsideration requests for denied services.
• Maintain accurate documentation of all authorization activities within the electronic medical record (EMR) and practice management systems. 
• Collaborate with scheduling, clinical, and billing departments to reduce delays and support revenue cycle performance.

PM20

• Qualified applicants should have a minimum of 1-3 years of healthcare authorization, insurance verification, medical billing, &/or revenue cycle experience. 
• Experience working with multiple commercial insurers, Medicare, and Medicaid plans. 
• Experience in a physician practice, outpatient clinic, hospital, or specialty healthcare setting preferred.
• Good understanding of Insurance plans and medical necessity guidelines.
• Good knowledge of medical terminology & anatomy.
• Proficient with ICD-10 & CPT codes. 
• previous experience with pre-certifying surgical procedures 
• Excellent oral and written communication skills required.
• Proficiency with EMR and practice management systems.

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