PreCert Specialist - Full-Time - Germantown, TN

PreCert Specialist - Full-Time - Germantown, TN

The PreCert Specialist plays a critical role as the front-line defense ensuring that patients have the required precertification for procedures, drugs, and radiology services. This position is also responsible for entering patient information into the system. The PreCert Specialist serves as a key resource for patients, providers, and staff by navigating insurance requirements, obtaining authorizations, and ensuring accurate documentation.

Verify demographic and insurance information including co-pays, deductibles, stop losses, guarantors, subscribers, and medical policy requirements

Update demographic and insurance records in a timely and accurate manner

Obtain and review physician orders for medical necessity and coverage requirements

Research insurance coverage criteria using payer policies, medical literature, and compendiums

Generate and review computer-based appointment reports

Communicate proactively with medical teams to ensure criteria are met for authorization

Obtain and review authorizations to ensure appropriate payment on the backend

Review self-pay patients, confirm status, and coordinate with patient assistance programs if applicable

Support appeals and peer-to-peer requests for precertification denials

Assist medical teams with cases returned from the office site team to resolve issues

Maintain compliance with policies, procedures, and performance standards

Other duties as assigned

High school diploma or equivalent

Minimum three years' experience in healthcare insurance or medical clinic, with emphasis on obtaining precerts/predeterminations

Experience reviewing medical necessity, payer policies, and medical coverage criteria

Experience in high-volume medical clinic or healthcare environment

Experience with chemotherapy and radiology precertifications

Strong knowledge of managed care, medical terminology, precert processes, and insurance claims processing

Familiarity with coding systems (ICD-9, ICD-10, CPT, HCPCS) for chemotherapy precertification requests

Proficiency with Microsoft Office applications and multiple healthcare systems/websites

Excellent navigational skills using intranet and internet resources

Strong organizational skills with ability to handle high patient volumes

Excellent problem-solving skills and high attention to detail

Strong written and verbal communication abilities

Knowledge of clinical coverage guidelines and medical policies

Meaningful Impact: Play a direct role in supporting patients through one of the most challenging times of their lives.

Collaborative Culture: Work alongside a multidisciplinary team of dedicated professionals committed to improving cancer care.

Professional Development: Benefit from ongoing training, educational resources, and growth opportunities.

Mission-Driven Environment: Be part of an organization guided by compassion, integrity, and innovation.

No nights, weekends, or holidays. Comprehensive benefits package.