Revenue Cycle Precert Specialist

University Hospitals•Shaker Heights, OH

About The Position

The Revenue Cycle Precert Specialist obtains and verifies insurance authorizations before outpatient testing, ambulatory procedures, and inpatient services. The role supports patients and providers by helping prevent delays in care, ensuring services meet payer requirements, and supporting timely reimbursement. The specialist reviews insurance eligibility, coverage, benefits, and payer requirements; submits authorization requests and supporting clinical documentation; and uses electronic eligibility tools, payer websites, and direct communication with insurers to resolve authorization needs. The role collaborates with providers, clinical teams, and operational departments, communicates authorization updates and potential issues, and maintains accurate documentation in electronic systems. The position requires professional customer service and communication with patients, providers, payers, and internal colleagues. The specialist follows organizational policies, payer guidelines, privacy and security requirements, and Revenue Cycle standards; participates in training and team meetings; and meets established quality, productivity, and service standards. Other duties may be assigned, and department-specific training and orientation are provided.

Requirements

High school equivalent or GED.
At least 3 years of experience in hospital Revenue Cycle/healthcare, working with insurance companies/third-party payers, or related experience.
Knowledge of managed care insurance requirements.
Notable client service, communication, and relationship-building skills.
Ability to function independently and as a team player in a fast-paced environment.
Strong written and verbal communication skills.
Professional demeanor.
Detail-oriented and organized, with analytical and problem-solving ability.
Ability to use PCs, Microsoft Office suite, and general office equipment.

Nice To Haves

Medical Terminology program from an accredited institution.
Experience with clinical applications.

Responsibilities

Obtain and verify prior authorizations for outpatient testing, ambulatory procedures, and inpatient services before care is delivered.
Review insurance eligibility, coverage, benefits, and payer requirements to help ensure services are authorized and reimbursable.
Use electronic eligibility tools, payer websites, and direct communication with insurance companies to verify coverage and resolve authorization needs, including out-of-network and non-covered services.
Submit authorization requests, notifications, clinical documentation, and supporting information in accordance with payer guidelines and contractual requirements.
Partner with providers, clinical teams, and operational departments to gather necessary documentation and keep the authorization process moving efficiently.
Communicate authorization updates, potential delays, denials, and peer-to-peer review requests while following established policies and escalation procedures.
Provide professional customer service to patients, providers, payers, and internal team members through phone, email, and other correspondence.
Stay current on insurance regulations, managed care requirements, government payer guidelines, and Revenue Cycle policies.
Scan, retrieve, and maintain required documentation within electronic systems.
Participate in team meetings, training, and ongoing learning opportunities while maintaining patient and physician confidentiality.
Meet established quality, productivity, and service standards.
Perform other duties as assigned.
Follow organizational policies, procedures, and standards.
Safeguard Protected Health Information by adhering to HIPAA requirements, the UH Code of Conduct, annual training, and applicable privacy and security policies.