Precertification Specialist
About The Position
Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met before inpatient, outpatient, and ancillary services are delivered. The Specialist determines which patient services have third-party payer requirements and obtains necessary authorizations through phone, fax, or payer websites. The role involves timely, detailed communication with payers and clinical partners to support compliance with payer contractual requirements, as well as documenting appropriate information in patient records. Other duties may be assigned.
Requirements
- High school degree or equivalent.
- One year of work experience.
Responsibilities
- Verify patient eligibility and obtain insurance benefits.
- Ensure pre-certification, authorization, and referral requirements are met before services are delivered.
- Determine which patient services have third-party payer requirements.
- Obtain necessary authorizations by phone, fax, or payer websites.
- Communicate detailed and timely information to payers and clinical partners.
- Document appropriate information in the patient's record.
- Perform other duties as assigned.
Benefits
- Health, dental, vision, and life insurance
- Employer-sponsored retirement plan
- Paid time off and extended sick leave
- Paid parental leave
- Disability insurance plan options
- Continuous professional and clinical training
- Competitive pay
- Annual merit increase
- Wellbeing resources
- Tuition reimbursement
- Employee perks and discounts
- Employee referral program
- Flexible schedule option
- Certification incentive program
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
