Pre-Cert Coordinator

Clearway Pain; Pensacola (FL); On-site; USD 25,000 - 33,000; Full time

Job summary

Clearway Pain is seeking a Pre-Cert Coordinator to support the authorization workflow. You will verify benefits, obtain pre-authorizations, and manage specialty pharmacy processing where applicable.

You will coordinate with physicians, payors, and patients, maintaining HIPAA confidentiality and upholding high service standards. The role requires a high school diploma or equivalent with at least two years of related experience, solid Microsoft Office skills, and excellent communication abilities.

Qualifications

• High School Diploma, or equivalent with minimum 2 years related experience or an equivalent combination of education and/or experience.
• Knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).
• Excellent written and oral communication skills, including exceptional customer service.
• Ability to establish and maintain effective working relationships with doctors, clinical staff, coworkers and the public.
• Ability to work independently and in a team.
• Ability to follow verbal and written instructions.
• Flexibility in schedule.
• Patience and understanding during stressful patient health situations.
• Ability to multi-task and prioritize.
• Extreme attention to detail.
• Strong organizational skills.
• Ability to problem solve and reason.
• Meet predefined quality standards.
• Maintain professional attitude and appearance at all times.
• Working knowledge of CPT and ICD-10 coding rules.
• Strong insurance knowledge for third‑party payers.
• Working knowledge of healthcare field and medical terminology.
• Commitment to excellent customer service and professional conduct.

Responsibilities

• Verifies insurance benefits for all procedures and specialty medications.
• Coordinates with providers to obtain pre-authorizations and documents findings.
• Manages specialty pharmacy processing and delivery where applicable.
• Reviews clinical data against medical terms and authorizes requests.
• Collaborates with departments to ensure prior authorization protocols.
• Coordinates with physicians, insurance companies and patients.
• Acts as patient liaison between insurers and physicians.
• Communicates patient information with ASC’s and other stakeholders.
• Maintains HIPAA confidentiality.
• Participates in trainings and completes required in-services.
• Performs other duties as assigned.

Skills

Communication skills

Customer service

Organization

Education

High school diploma or equivalent

Tools

MS Word

MS Excel

MS PowerPoint

MS Outlook

Job description

The Pre-Cert Coordinator supports the complete and timely work flow of the company’s authorization process. The individual is responsible for obtaining and processing all necessary information required to obtain precertification or authorizations, as required by payors.

Essential Duties and Responsibilities:

• Verifies all insurance benefits for all procedures and specialty medications.
• Coordinates with insurance providers, physicians and patients to obtain pre-authorizations on all specified procedures and specialty medications. Documents these findings in patient charts.
• Manages all specialty pharmacy processing and delivery for specified medications, once authorization is obtained (NE Region Only).
• Reviews clinical data matching it against specified medical terms and diagnoses and follow established procedures for authorizing request.
• Work with other departments to ensure prior authorization protocols are in place.
• Coordinates with physicians, insurance companies and patients.
• Works as patient liaison between the insurance companies and the physicians at the Company.
• Communicates necessary patient information with contracted ASC’s and other key stakeholders.
• Exercises confidentiality in all areas, abiding by HIPAA rules and regulations.
• Participates in and complete all required trainings and in-services.
• Performs other duties as assigned.

Minimum Qualifications:

• High School Diploma, or equivalent WITH a minimum of two (2) years related experience; OR an equivalent combination of education and/or experience.
• Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).
• Must have excellent written and oral communication skills, including exceptional customer service.
• Must be able to establish and maintain effective working relationships with doctors, clinical staff, other co-workers and the public.
• Must be able to work individually as well as within a team.
• Must be able to follow both verbal and written instructions.
• Must be able to work a flexible schedule.
• Must be able to respond with patience and understanding during stressful conditions related to patient health and emergent situations.
• Must be able to multi-task and prioritize.
• Must demonstrate extreme attention to detail.
• Must possess strong organization skills.
• Must be able to problem solve and use reasoning.
• Must be able to meet predefined quality standards.
• Must maintain and project a professional attitude and appearance at all time.
• Must have a working knowledge of CPT and ICD-10 coding rules.
• Must have a solid foundation of insurance knowledge and guidelines for third party payers.
• Must have a working knowledge of the healthcare field and medical specialty, as well as medical terminology.
• All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance.

Preferred Qualifications:

• Two (2) years’ experience working with an Electronic Medical Record (EMR).
• Two (2) years’ Pre-Cert Experience.
• Medical Coding Certification

Driving/Travel:

The employee must have reliable transportation. While the primary workplace may be closest to the employee’s home, work assignments could be in any of the Company’s locations.