Pre-Certification Specialist

Requirements:

• At least 1–3 years of experience in healthcare authorizations, insurance verification, medical billing, and/or revenue cycle work.
• Experience working with multiple commercial insurers, Medicare, and Medicaid plans.
• Experience in a physician practice, outpatient clinic, hospital, or specialty healthcare setting is preferred.
• Good understanding of insurance plans and medical necessity guidelines.
• Knowledge of medical terminology and anatomy.
• Proficiency with ICD-10 and CPT codes.
• Previous experience obtaining pre-certification for surgical procedures.
• Excellent oral and written communication skills.
• Proficiency with electronic medical records (EMR) and practice management systems.

Responsibilities:

• Verify patients insurance eligibility, benefits, and coverage.
• Obtain prior authorizations and pre-certifications for procedures, diagnostic tests, and specialty services.
• Review physician orders and supporting clinical records to identify authorization requirements.
• Send authorization requests and required medical records to insurance carriers.
• Track authorization approvals, denials, and expirations, and follow up on pending requests to support timely completion.
• Share authorization status and patients financial responsibility with providers, staff, and patients.
• Help prepare appeals and reconsideration requests for denied services.
• Maintain accurate records of authorization activities in our EMR and practice management systems.
• Work with scheduling, clinical, and billing teams to reduce delays and support revenue cycle performance.

Technologies:

• Support

More

We are seeking a highly organized, detail-oriented Pre-Certification Specialist to join our healthcare team. In this role, you will connect patients, providers, and insurance carriers to help ensure services meet payer requirements and are authorized before treatment. Your work will help limit claim denials, improve reimbursement, and support a positive patient experience. We offer competitive pay and benefits, including medical, dental, and vision coverage, paid personal time and holidays, a 401(k), and paid short- and long-term disability and life insurance. Our work schedule is Monday through Friday, and we offer opportunities for growth and advancement.

last updated 43 week of 2026