Patient-Focused Pre-Certification & Authorization Specialist

University Otolaryngologists; United States; A distancia; USD 25.000 - 34.000; Jornada completa

Descripción de la vacante

University Otolaryngologists is seeking a highly organized Pre-Certification Specialist to obtain insurance authorizations and verify patient benefits, ensuring services are approved before treatment.

The role acts as a liaison between patients, providers and carriers, aiming to minimize denials and improve reimbursement while supporting a positive patient experience. Monday–Friday work schedule with competitive pay and benefits.

Formación

• 1-3 years healthcare authorization or verification experience.
• Experience with commercial insurers, Medicare and Medicaid.
• Experience in a physician practice, outpatient clinic, hospital, or specialty setting.
• Understanding of insurance plans and medical necessity guidelines.
• Proficient with ICD-10 & CPT codes.
• Excellent oral and written communication skills.
• Proficiency with EMR and practice management systems.

Responsabilidades

• Verify patient insurance eligibility, benefits, and coverage.
• Obtain prior authorizations and pre-certifications for procedures and tests.
• Review physician orders and clinical documentation for authorization requirements.
• Submit authorization requests and medical records to insurance carriers.
• Monitor approvals, denials, and expirations; follow up as needed.
• Communicate authorization status and patient financial responsibility to providers and staff.
• Assist with appeals and reconsideration requests for denied services.
• Maintain accurate documentation in the EMR and practice management systems.
• Collaborate with scheduling, clinical, and billing teams to reduce delays.

Conocimientos

Communication

Attention to detail

Organization

Customer service

Herramientas

EMR systems

Practice management software

Descripción del empleo

University Otolaryngologists is seeking a highly organized Pre-Certification Specialist to obtain insurance authorizations and verify patient benefits, ensuring services are approved before treatment.

The role acts as a liaison between patients, providers and carriers, aiming to minimize denials and improve reimbursement while supporting a positive patient experience. Monday–Friday work schedule with competitive pay and benefits.