Medical Insurance Pre-Certification Specialists

ENT & Allergy Specialists • Fort Thomas, KY

79d

About The Position

We are seeking a detail-oriented and proactive Insurance Pre-Certification Specialist to join our team. This role is responsible for managing insurance pre-certifications, verifying patient benefits and deductibles, and ensuring timely follow-up to support surgical scheduling and billing accuracy.

Requirements

• Proven experience in insurance pre-certification within a medical or surgical setting.
• Strong understanding of medical billing and coding (CPT/ICD codes preferred).
• Excellent organizational and multitasking skills.
• Ability to work independently and collaboratively within a team.
• Professional phone etiquette and effective communication skills (oral and written).
• Familiarity with insurance providers and their authorization processes.
• Proficiency in computer systems and electronic health records (EHR).
• Associate degree or equivalent college coursework preferred.

Responsibilities

• Manage and follow up on all pre-admission and pre-certification processes for multiple provider and office locations.
• Submit pre-certification requests via insurance portals (e.g., Humana, UnitedHealthcare) and through direct communication with insurance providers.
• Verify and input accurate procedure codes to ensure correct pre-certification for scheduled surgeries.
• Assess patient deductibles, including HSA accounts, and determine pre-surgical financial responsibilities.
• Maintain organized and up-to-date records of all pre-certified cases, including necessary updates and changes.
• Communicate regularly with insurance companies, patients, and internal staff to ensure timely approvals.
• Send deductible letters and follow up on outstanding or pending cases.
• Reprocess pre-certifications when surgical procedures differ from initial expectations.

What This Job Offers

• Education Level: Associate degree
• Number of Employees: 51-100 employees