Pre Cert Rep - DeKalb Patient Accounting - FT - 1st Shift

Huntsville Hospital Health System•Fort Payne, AL

About The Position

The Outpatient Pre-Certification Representative is responsible for obtaining prior authorizations for outpatient procedures, diagnostic services, and treatments. This role ensures all scheduled outpatient services meet insurance requirements prior to the date of service, helping reduce denials and delays while supporting efficient patient care.

Requirements

High school diploma or GED required; healthcare-related education preferred.
1–3 years of experience in insurance verification, pre-certification, or medical billing (outpatient preferred).
Knowledge of outpatient procedures and insurance authorization processes.
Strong attention to detail and accuracy
Excellent communication and coordination skills
Ability to manage high-volume workload and meet deadlines
Problem-solving skills for handling authorization issues and denials
Strong organizational and multitasking abilities

Nice To Haves

Familiarity with CPT, ICD-10, and HCPCS coding (preferred).

Responsibilities

Obtain pre-authorizations for outpatient procedures such as imaging, surgeries, therapies, and specialty services
Verify patient insurance eligibility, benefits, and coverage for outpatient services
Review physician orders and clinical documentation to determine authorization requirements
Submit authorization requests to insurance providers with appropriate clinical information
Track and follow up on pending authorizations to ensure timely approval before scheduled services
Communicate authorization status to scheduling teams, clinical staff, and patients
Identify services that do not require authorization and document appropriately
Resolve authorization issues, including denials or incomplete requests
Maintain accurate documentation of all interactions and approvals in electronic systems
Ensure compliance with payer guidelines and hospital policies