Hybrid Pre-Certification Specialist - Prior Authorizations

Gosnaphop; Houston (TX); Hybrid; USD 32,000 - 33,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

401k

Job summary

Addison Group is seeking a Pre-Certification Specialist in Houston, TX. The role concentrates on obtaining authorizations for procedures and working with commercial payers to ensure approvals before treatment.

Expect a hybrid schedule with training onsite initially. The candidate should have 3+ years of prior authorization experience, strong Excel skills, and the ability to manage multiple EMR systems while communicating with payers.

Qualifications

• 3+ years of prior authorization/precertification experience required.
• Experience obtaining authorizations for procedures.
• Strong understanding of the complete authorization process and payer follow-up.
• Experience reviewing clinical documentation and diagnosis codes.
• Comfortable discussing clinical information directly with insurance payers.
• Experience entering authorization information into EMR systems.
• Working knowledge of Excel.

Responsibilities

• Obtain prior authorizations/precertifications for procedures and diagnostics.
• Manage high-volume authorization requests (40+ per day).
• Verify patient insurance eligibility and benefits.
• Communicate requirements and status with commercial payers.
• Review documentation and diagnosis codes for authorization support.
• Discuss clinical information with payers and respond to questions.
• Enter authorization data into EMR systems.
• Track requests through completion and follow up on items.
• Review EOBs and research discrepancies as needed.
• Pull information from EMR and manage tracking in Excel.

Skills

Prior authorization experience

Authorization for procedures

Payer follow-up

Clinical documentation review

Discuss clinical information with paye

EMR data entry

Excel proficiency

Research and problem solving

Independent work multitasking

Tools

EMR systems

Excel

Job description

Addison Group is seeking a Pre-Certification Specialist in Houston, TX. The role concentrates on obtaining authorizations for procedures and working with commercial payers to ensure approvals before treatment.

Expect a hybrid schedule with training onsite initially. The candidate should have 3+ years of prior authorization experience, strong Excel skills, and the ability to manage multiple EMR systems while communicating with payers.