Precertification Specialist - Surgery

Delaware Valley Management•Newtown, PR

6h•Remote

About The Position

Surgical Precertification Specialist Full-Time – Remote MUST LIVE IN NJ, PA OR FL Position Summary This role handles the end-to-end authorization process for commercial insurance carriers to make sure surgical cases get approved correctly, cleanly, and on time. The specialist works closely with surgeons, schedulers, patients, and insurance reps to keep cases moving and prevent last-minute surprises. Key Responsibilities Review surgery requests for accuracy, completeness, and medical necessity documentation Submit prior authorization requests to payers; track and follow up until determination Communicate case status to surgeons, schedulers, clinical staff, and patients Verify benefits insurance is active to obtain authorization Request and collect clinical records, imaging reports, and supporting documentation Handle peer-to-peer requests, denials, and appeals coordination Maintain organized case logs and meet turnaround time expectations Identify payer quirks, trends, and requirements to prevent delays Maintain flexibility within the role to deliver the best possible patient care Work collaboratively with the rest of the precertification team to keep workflows tight and predictable Provide excellent customer service

Requirements

MUST live in NJ, PA or FL
Experience with precertification or prior authorization for surgical services
Strong understanding of medical terminology, CPT/ICD-10 codes, and clinical documentation
Comfort working with EMRs, payer portals, Microsoft and Adobe
Solid communication skills — clear, direct, and calm
Ability to juggle multiple cases without losing track
Detail-oriented with good judgement on what needs escalation and what just needs another phone call
High level of reliability and follow-through

Nice To Haves

Neuro/spine surgery experience preferred but not required

Responsibilities

Review surgery requests for accuracy, completeness, and medical necessity documentation
Submit prior authorization requests to payers; track and follow up until determination
Communicate case status to surgeons, schedulers, clinical staff, and patients
Verify benefits insurance is active to obtain authorization
Request and collect clinical records, imaging reports, and supporting documentation
Handle peer-to-peer requests, denials, and appeals coordination
Maintain organized case logs and meet turnaround time expectations
Identify payer quirks, trends, and requirements to prevent delays
Maintain flexibility within the role to deliver the best possible patient care
Work collaboratively with the rest of the precertification team to keep workflows tight and predictable
Provide excellent customer service