Pre-Certification Specialist

LOUISIANA WOMENS HEALTHCARE•Baton Rouge, LA

1d•Onsite

About The Position

Seeking a full-time Pre-Certification Specialist to support a high-volume OB-GYN clinic. This position is responsible for obtaining insurance benefits, verifying eligibility, and securing pre-authorizations for a wide range of procedures and services. The specialist serves as a key liaison between providers, patients, and insurance companies to ensure timely approvals and minimize delays in care.

Requirements

High school diploma or equivalent.
Previous experience in a medical office or healthcare setting .
Working knowledge of insurance authorization requirements and workflows.
Understanding of HIPAA and strict adherence to patient confidentiality standards.
Must demonstrate punctuality and reliable attendance.

Nice To Haves

Experience in an OB-GYN or Family Practice setting preferred.
Proficiency with EMR systems, Epic preferred.

Responsibilities

Verifying insurance coverage and eligibility – Confirm patients’ insurance benefits, in-network status, and any authorization requirements.
Communication– Communicate with physicians’ staff, insurance representatives, and patients to clarify coverage, authorization issues, and estimated amount due.
Obtain prior authorizations: Complete the authorization process with commercial payers, Medicare, Medicaid, and others to ensure coverage.
Maintain documentation – Keep accurate records of benefits, patient information, and authorization status.
Gather and submit documentation: Collect all required clinical and administrative information from referring physicians, patients, or third-party facilities.
Maintain compliance: Work within HIPAA and payer-specific protocols to protect patient privacy and ensure regulatory compliance.
Follow up and resolve issues: Track authorization status, and address denials.
Benefits - ensure all new obstetrical patients, pre-ops and office procedures scheduled have benefits completed, documented and provided to Patient Accounts.
System maintenance – Update insurance policy information and/or patient demographics, in system when needed, to ensure proper processing.