Precertification Specialist
On-siteWabash, Indiana, United States
Job Summary
Obtain insurance precertifications and prior authorizations for surgical procedures by verifying eligibility, benefits, and coverage requirements. Review scheduled procedures and clinical documentation to ensure payer guidelines are met, then submit accurate authorization requests with supporting medical records. Communicate with insurance companies regarding status, documentation requests, denials, and appeals while coordinating with surgeons, schedulers, and patients to resolve coverage concerns. Monitor pending authorizations and expiration dates to prevent delays, maintain accurate documentation in electronic medical records, and stay informed of regulatory changes. Protect patient confidentiality and ensure compliance with HIPAA policies.
Required Qualifications
- High school diploma or equivalent
- Associate degree in healthcare administration or a related field preferred
- Previous experience with insurance verification, prior authorizations, precertification, medical billing, or healthcare administration preferred
- Knowledge of medical terminology, insurance plans, CPT codes, and ICD-10 codes preferred
- Strong attention to detail
- Commitment to maintaining accurate documentation
- Excellent organizational skills
- Time-management skills
- Problem-solving skills
- Ability to prioritize multiple requests
- Ability to meet deadlines
- Ability to work in a fast-paced environment
- Strong written communication skills
- Strong verbal communication skills
- Ability to communicate with patients
- Ability to communicate with insurance representatives
- Ability to communicate with providers
- Ability to communicate with clinical teams
- Proficiency with electronic medical records
- Proficiency with Microsoft Office
- Proficiency with other healthcare-related systems
- Ability to work independently
- Ability to contribute to a collaborative team environment
- Close visual acuity
- Ability to stand for sustained periods of time
- Ability to stoop
- Ability to grasp
- Ability to lift up to 15 lbs on a regular basis from floor to waist
- Ability to lift 5 lbs from waist to shoulder
- Ability to lift 5 lbs from shoulder to overhead
- Ability to talk
- Ability to hear
Desired Qualifications
- Associate degree in healthcare administration or a related field preferred
- Previous experience with insurance verification, prior authorizations, precertification, medical billing, or healthcare administration preferred
- Knowledge of medical terminology, insurance plans, CPT codes, and ICD-10 codes preferred
- Strong attention to detail and a commitment to maintaining accurate documentation
- Excellent organizational, time-management, and problem-solving skills
- Ability to prioritize multiple requests and meet deadlines in a fast-paced environment
- Strong written and verbal communication skills
- Comfortable communicating with patients, insurance representatives, providers, and clinical teams
- Proficiency with electronic medical records, Microsoft Office, and other healthcare-related systems
- Ability to work independently while contributing to a collaborative team environment
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