Pre-Certification Specialist

Ohio ENT & Allergy Physicians • Columbus, OH

3d

About The Position

We are seeking a highly organized and detail-oriented Pre-Certification Specialist to obtain insurance authorizations and verify patient benefits so services are approved before treatment. The role serves as a liaison between patients, providers, and insurance carriers to ensure medical services meet payer requirements and are authorized before treatment. The specialist helps minimize claim denials, improve reimbursement, and support a positive patient experience. The ideal candidate is knowledgeable in insurance processes, thrives in a fast-paced environment, and is committed to supporting patients and providers. The organization offers opportunities for growth and advancement. Work schedules are Monday through Friday.

Requirements

• Minimum of 1–3 years of healthcare authorization, insurance verification, medical billing, and/or revenue cycle experience.
• Experience working with multiple commercial insurers, Medicare, and Medicaid plans.
• Good understanding of insurance plans and medical necessity guidelines.
• Good knowledge of medical terminology and anatomy.
• Proficiency with ICD-10 and CPT codes.
• Excellent oral and written communication skills.
• Proficiency with EMR and practice management systems.

Nice To Haves

• Experience in a physician practice, outpatient clinic, hospital, or specialty healthcare setting.
• Previous experience with pre-certifying surgical procedures.

Responsibilities

• Verify patient insurance eligibility, benefits, and coverage.
• Obtain prior authorizations and pre-certifications for procedures, diagnostic testing, and specialty services.
• Review physician orders and supporting clinical documentation for authorization requirements.
• Submit authorization requests and required medical records to insurance carriers.
• Monitor and track authorization approvals, denials, and expirations.
• Follow up on pending requests to ensure timely completion.
• Communicate authorization status and patient financial responsibility to providers, staff, and patients.
• Assist with appeals and reconsideration requests for denied services.
• Maintain accurate documentation of authorization activities within electronic medical record (EMR) and practice management systems.
• Collaborate with scheduling, clinical, and billing departments to reduce delays and support revenue cycle performance.

Benefits

• Competitive salary and benefits package.
• Medical, dental, and vision coverage.
• Paid personal time.
• Paid holidays.
• 401(k).
• Paid short-term disability, long-term disability, and life insurance.
• Opportunities for growth and advancement.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed