Insurance Authorization Specialist

Nebraska Spine + Pain Center Careers; Nebraska; On-site; USD 25,000 - 36,000; Full time

Job summary

Nebraska Spine and Pain Center's Business Office seeks a Pre-Certification Specialist to manage insurance authorization for outpatient and surgical procedures. This full-time, non-exempt position works with payers to obtain determinations while ensuring HIPAA compliance.

Remote candidates will not be considered. You will handle pre-certification submissions, follow ups, and maintain accurate payer communications in the EHR, supporting physicians and patients.

Qualifications

• Excellent verbal and written communication skills required.
• Understanding of medical terminology and payer processes preferred.
• Experience with insurance authorization and medical billing is a plus.

Responsibilities

• Performs pre-certification for outpatient procedures and surgeries.
• Submits clinical documentation to payers and tracks determinations.
• Keeps payer communications and statuses accurate in the EHR.
• Answers patient inquiries and provides status updates per HIPAA rules.
• Escalates complex cases to clinical or coding staff when needed.

Skills

Verbal and written communication

Telephone etiquette

Attention to detail

Education

High school diploma or equivalent

Experience in medical insurance authorization or medical billing

Job description

Description

Pre-Certification Specialist- Remote Candidates will not be considered.

The Role: Full Time | Non-Exempt / Hourly | Administrative, Business Office

At Nebraska Spine and Pain Center, we are a multi-specialty medical practice built around one goal: getting patients the care they need without the runaround. Our Business Office is the engine behind that promise, and the people in it work closely with physicians, advanced practice providers, and clinic leadership every day. If you are looking for a role where you work actually makes a positive impact on patients, Nebraska Spine and Pain Center is your place!

Position Overview

Join our Business Office and be the person who gets patients from "ordered" to "approved." This role handles pre-certification and insurance authorization for outpatient and surgical procedures. You'll work directly with payers to obtain and track coverage determinations, all in compliance with HIPAA and current payer and coding standards.

Essential Job Functions

• Performs pre-certification of outpatient procedures, including MRI, CT, injection, and in-house procedures, based on the ordering provider’s clinical order and current payer medical-policy criteria.
• Performs pre-certification of surgical procedures, submitting clinical documentation provided by the ordering physician or advanced practice provider.
• Follows up on pending pre-certifications with insurance carriers within established turnaround-time standards.
• Maintains working knowledge of CPT and ICD-10-CM coding conventions sufficient to support accurate, compliant pre-certification submissions; escalates coding questions requiring clinical judgment to the appropriate clinical or coding staff.
• Answers patient phone calls and provides status updates on pre-certification requests, disclosing only the minimum necessary protected health information consistent with HIPAA privacy standards.
• Documents all payer communications, determinations, and pre-certification status accurately and timely in the practice management system/EHR.
• Does not render independent medical necessity determinations; medical necessity and clinical appropriateness decisions remain with the ordering provider and, where applicable, the payer’s clinical reviewer.

Additional Responsibilities

• Assist business office staff with outpatient scheduling for imaging, injections and surgical
• Provide float or cross-coverage support to other departments as needed.
• Other duties may be assigned at times as determined by a supervisor to meet the needs of the organization
• Duties, responsibilities, and activities may change without prior notice.

Requirements

Physical

• Prolonged periods of sitting at a desk and working on a computer
• Prolonged periods of phone-based communication
• Ability to lift up to 10 pounds occasionally
• Ability to manage multiple competing tasks and deadlines
• High attention to detail and accuracy

Required Knowledge/Skills/Abilities

• Knowledge of insurance terms, medical terminology, CPT and ICD-10 codes preferred
• Excellent verbal and written communication skills required
• Excellent telephone etiquette
• Detail oriented
• High school diploma or equivalent; prior experience in medical insurance authorization, medical billing, or a related healthcare business-office function preferred