Healthcare Precertification & Authorization Specialist

nghs; Gainesville (GA); On-site; USD 38,000 - 52,000; Full time

Job summary

Northeast Georgia Health System in Georgia seeks a proactive Administrative & Clerical specialist to handle pre-certification and insurance verification for inpatient and outpatient services. You will work under the Utilization Review Manager, deliver excellent customer service, determine patient responsibility, gather clinical data, and coordinate with physicians and payers to secure approvals.

Qualifications include a high school diploma or GED, preferred CPC/AAPC/AHIMA certification, and 3–5

Qualifications

• High School Diploma or GED required.
• Preferred certifications: AAPC, AHIMA or CPC.
• 3–5 years of experience in insurance authorization or related healthcare operations preferred.
• Excellent problem solving and communication skills.

Responsibilities

• Pre-authorize inpatient and outpatient accounts per guidelines.
• Interpret clinical information to support pre-certifications.
• Coordinate with physicians, case management and payers for data.
• Verify insurance eligibility for hospital visits.
• Document verification and authorization activities accurately.
• Assist with appeals and process improvement initiatives.
• Meet customer service and productivity targets.

Skills

Problem solving

Analytical skills

Written and verbal communication

Prioritize and organize workload

PHI knowledge

Adapt to change

Medical terminology

Education

High School Diploma or GED

AAPC/AHIMA/CPC certification preferred

Job description

Northeast Georgia Health System in Georgia seeks a proactive Administrative & Clerical specialist to handle pre-certification and insurance verification for inpatient and outpatient services. You will work under the Utilization Review Manager, deliver excellent customer service, determine patient responsibility, gather clinical data, and coordinate with physicians and payers to secure approvals.

Qualifications include a high school diploma or GED, preferred CPC/AAPC/AHIMA certification, and 3–5