Pre-Certification Specialist

Southwoods Health • Boardman, OH

2d • Onsite

About The Position

Southwoods Health is seeking a detail-oriented Pre-Certification Specialist to work at the Southwoods Executive Centre in Boardman, Ohio. The specialist requests and obtains insurance authorizations for procedures and imaging ordered by Southwoods Health physicians. The role includes managing authorizations, collecting and investigating patient information, resolving insurance and eligibility issues, communicating with referral sources and internal staff, maintaining confidential records in electronic medical records and specialized databases, and supporting role-specific documents and processes.

Requirements

• Specialized courses or training in medical terminology, business office operations, and computer applications.
• At least two years of experience handling medical procedure and imaging pre-authorizations across multiple modalities and specialties.
• Expertise in insurance verification.
• Strong problem-solving capabilities and meticulous attention to detail.
• Excellent interpersonal skills and the ability to maintain a highly professional demeanor, strong ethical standards, and moral principles.

Nice To Haves

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

Responsibilities

• Request, track, obtain, and extend pre-authorizations from insurance carriers in a timely manner.
• Gather accurate, detailed patient data and investigate alternative payment sources to initiate services.
• Assist with resolving complex insurance issues, re-authorizations, and patient eligibility discrepancies.
• Respond promptly to referral sources requesting supporting documentation, medical reports, or clinical information.
• Record and update insurance details in internal databases to keep pertinent staff informed of payer verifications or benefit changes.
• Maintain patient confidentiality and adhere to applicable federal, state, and regulatory guidelines, including OSHA, ODH, BOP, and TJC requirements across physician practices.
• Independently maintain records and workflows using electronic medical records (EMR) and specialized databases.
• Assist in developing, organizing, and maintaining role-specific documents, policies, and process tools.

What This Job Offers

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