Pre-Certification Specialist

Benefits

• Dental insurance
• Health insurance
• Vision insurance

Key Responsibilities

• Pre-Certification & Authorization Management
• - Obtain prior authorizations and pre-certifications for medical procedures, diagnostic testing, imaging, medications, specialty services, and office-based procedures.
• - Verify insurance eligibility, benefits, coverage limitations, and authorization requirements.
• - Submit complete and accurate clinical information to insurance carriers to support medical necessity.
• Procedure Knowledge & Coordination
• - Demonstrate preferred knowledge of spinal injections, joint injections, pain management procedures, neurology-related services, and associated payer requirements.
• - Understand procedure-specific authorization guidelines and medical necessity criteria.
• - Coordinate with providers and clinical staff regarding procedure scheduling pending authorization approval.
• CPT Coding & Documentation
• - Maintain working knowledge of CPT, ICD-10, and HCPCS coding, with preferred experience interpreting CPT codes related to spinal and joint injection procedures.
• - Review physician orders, clinical documentation, and coding information to ensure authorization accuracy and completeness.
• - Ensure all supporting medical records and documentation meet insurance and regulatory standards.
• Communication & Coordination
• - Serve as a liaison between healthcare providers, insurance companies, patients, and clinical staff to facilitate efficient authorization processing.
• - Communicate authorization statuses, denials, and additional documentation requirements to appropriate team members.
• - Educate patients, when appropriate, regarding insurance authorization requirements and scheduling delays.
• Follow-Up & Denial Management
• - Track and follow up on pending authorization requests to ensure timely approvals and avoid disruptions in patient care.
• - Investigate, appeal, and assist in resolving denied or delayed authorization requests.
• - Maintain detailed records of authorization statuses, reference numbers, and payer communications.
• Data Entry & Record Maintenance
• - Accurately enter and maintain authorization and pre-certification information within the Electronic Health Record (EHR) and other applicable systems.
• - Maintain organized records of approvals, denials, expiration dates, and payer requirements.
• Compliance & Regulatory Awareness
• - Stay current on insurance policies, payer updates, prior authorization requirements, and regulatory guidelines.
• - Ensure compliance with HIPAA, payer regulations, and organizational policies and procedures.

Qualifications

• Education
• - High School Diploma or equivalent required.
• - Associate’s or Bachelor’s degree in Healthcare Administration, Medical Billing & Coding, Business Administration, or a related healthcare field preferred.
• Experience
• - Minimum of 2–3 years of experience in a healthcare, medical office, or insurance setting with a focus on prior authorizations, pre-certification, or insurance verification preferred.
• - Neurology, pain management, orthopedic, or specialty medical office experience preferred.
• Skills & Knowledge
• - Strong knowledge of insurance pre-certification, prior authorization, and payer requirements.
• - Preferred knowledge of spinal injections, joint injections, and specialty procedure authorization workflows.
• - Working knowledge of CPT, ICD-10, and HCPCS codes, with preference given to candidates familiar with injection-related CPT coding.
• - Strong attention to detail and organizational skills.
• - Excellent communication and interpersonal skills.
• - Proficiency in Electronic Health Records (EHR) and medical office software.
• - Ability to multitask, prioritize, and work independently in a fast-paced environment.
• Preferred Certifications
• - Certified Professional Coder (CPC) preferred but not required.
• - Medical billing and coding certification is a plus.

What We Offer

• Competitive salary and benefits package
• Health, dental, and vision insurance
• Retail savings plan with company match
• Opportunities for professional development and growth
• Supportive, team-oriented work environment

Compensation

$15.00 - $20.00 per hour