Pre-Certification Specialist

Southwoods Health•Boardman, OH

1d•Onsite

About The Position

Southwoods Health is seeking a detail-oriented Pre-Certification Specialist to join our growing team at the Southwoods Executive Centre. In this role, you will be responsible for requesting and obtaining insurance authorizations for procedures and imaging ordered by Southwoods Health physicians.

Requirements

Specialized courses or training in medical terminology, business office operations, and computer applications.
Minimum of two (2) years of experience handling medical procedure and imaging pre-authorizations across multiple modalities and specialties.
Proven insurance verification expertise, strong problem-solving capabilities, and meticulous attention to detail.
Excellent interpersonal skills with the ability to maintain a highly professional demeanor, strong ethical standards, and moral principles at all times.

Nice To Haves

Family Practice (FP) or Internal Medicine (IM) office experience is highly preferred.

Responsibilities

Request, track, obtain, and extend pre-authorizations from various insurance carriers in a timely manner.
Gather accurate, detailed patient data and investigate alternative payment sources to initiate services.
Assist in resolving complex insurance issues, re-authorizations, and patient eligibility discrepancies.
Promptly respond to referral sources requesting supporting documentation, medical reports, or clinical information.
Record and update insurance details within internal databases to keep pertinent staff informed of payer verifications or benefit changes.
Maintain strict patient confidentiality and adhere to all federal, state, and regulatory guidelines (including OSHA, ODH, BOP, and TJC) across physician practices.
Independently maintain records and workflow utilizing electronic medical records (EMR) and specialized databases.
Assist in the development, organization, and maintenance of role-specific documents, policies, and process tools.