Pre-Certification Specialist

Job Description

Job Description

Position Overview:
The Pre-Certification Specialist will be responsible for obtaining necessary pre-certification approvals from insurance providers to ensure that patients receive the required services and procedures. This role requires strong communication skills, attention to detail, and the ability to work efficiently in a fast-paced environment.

Key Responsibilities:

• Pre-Certification Management: Obtain pre-certification approvals from insurance companies for medical procedures, services, and medications.
• Documentation: Collect and review all required documentation to ensure compliance with insurance and regulatory requirements.
• Communication: Serve as a liaison between healthcare providers, insurance companies, and patients to facilitate smooth pre-certification processes.
• Follow-Up: Track and follow up on pending pre-certification requests to ensure timely approvals.
• Data Entry: Accurately enter and maintain pre-certification data in the electronic health record (EHR) or other relevant systems.
• Problem Resolution: Address and resolve any issues or denials related to pre-certification requests.
• Compliance: Stay informed about changes in insurance policies, procedures, and regulatory requirements to ensure compliance.

Qualifications:

• Education: High School Diploma or equivalent required; Associate’s or Bachelor’s degree in healthcare administration, business, or a related field preferred.
• Experience: Minimum of [2-3] years of experience in a healthcare or insurance setting, with a focus on pre-certification or authorization processes.
• Skills:
  • Strong knowledge of insurance pre-certification and authorization procedures.
  • Excellent communication and interpersonal skills.
  • Proficiency in using electronic health records (EHR) systems and other relevant software.
  • Detail-oriented with strong organizational skills.
  • Ability to work independently and handle multiple tasks simultaneously.
• Certifications: [Any specific certifications required or preferred, e.g., Certified Professional Coder (CPC)]

What We Offer:

• Competitive salary and benefits package
• Comprehensive health, dental, and vision insurance
• Retirement savings plan with company match
• Opportunities for professional development and career growth
• Supportive and collaborative work environment

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