Pre-Authorization / Pre-Certification Specialist

Position Overview
We are seeking an experienced and detail-oriented Insurance Verification Specialist to process pre-certification and prior authorization requests for both inpatient and outpatient procedures. The ideal candidate ensures all patient insurance requirements are met before services are rendered, minimizing claim denials and reducing financial risk.

Key Job Duties

• Verification & Authorization: Verify patient eligibility and pre-certification requirements software or by telephone. Secure necessary prior authorizations for scheduled medical procedures.
• Re-Verification: Systematically re-verify patient eligibility and benefits on a monthly basis to ensure active coverage.
• Coding Accuracy: Obtain authorization using correct CPT (Current Procedural Terminology) and ICD-10 (International Classification of Diseases, 10th Revision) codes
• Data Management: Track and manage authorization requests in Microsoft Excel and electronic health record (EHR) systems.
• Communication: Coordinate with clinical staff, patients, and insurance carriers to resolve pending or denied requests.

Experience & Skills Required

• Prior experience performing pre-certifications, insurance verifications, and authorizations at a high volume for inpatient and outpatient procedures.
• Strong technical proficiency in Microsoft Word and Microsoft Excel.
• Knowledge of CPT and ICD coding systems is a strong plus