Pre-Cert Coordinator I

Neurosciences and Spine Group; City of Binghamton (NY); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Hands-on training

Clear workflows

Supportive team environment

Job summary

Neurosciences and Spine Group is seeking a detail-oriented Pre-Cert Coordinator I to ensure services are properly authorized and financially cleared before visits. You will verify coverage, obtain authorizations, and communicate with payers and clinical staff to keep care on schedule.

Under supervision, you will perform routine to moderately complex authorization tasks, follow payer guidelines, and escalate issues as needed to senior staff.

Qualifications

• High School Diploma or equivalent required.
• Basic knowledge of prior authorization and insurance terminology preferred.
• Proficient with computers, online payer portals, and standard office applications.
• Strong attention to detail and ability to follow established procedures.
• Effective written and verbal communication skills.
• Cooperative, positive team player comfortable working within defined workflows.
• Familiarity with neurosurgical or spine-related procedures, imaging, and terminology preferred.

Responsibilities

• Verifies insurance eligibility and benefit coverage prior to scheduled services using our EHR and payer portals.
• Confirms active coverage dates, plan requirements, and authorization dependencies to ensure services are financially cleared.
• Performs eligibility rechecks as needed when service dates change or coverage requires validation.
• Identifies coverage or eligibility discrepancies and escalates per established workflows.
• Obtains initial insurance authorizations for neurosurgical and spine procedures, including surgeries, injections, and other interventional treatments, submitting requests via payer portals, fax, or phone.
• Obtains authorization for advanced imaging (MRI, CT) and diagnostic testing (e.g., EMG/NCS) ordered in support of neurosurgery and spine evaluations.
• Obtains authorization for durable medical equipment related to neurosurgery and spine care, such as braces and neurostimulators, when applicable.
• Enters authorization numbers and coverage details into the electronic health record.
• Reviews surgery and procedure schedules to confirm authorization coverage is secured well ahead of the scheduled date, prioritizing time-sensitive and urgent cases.
• Follows up on pending authorizations using established timelines, escalating urgent or approaching-deadline cases promptly.
• Documents payer determinations accurately and communicates authorization status to surgeons, clinical staff, and case management.
• Notifies leadership immediately of authorization delays or missing information that could impact a scheduled surgery or procedure.
• Works assigned work queues and portals under supervision, following departmental workflows and documentation standards.

Skills

Attention to detail

Written and verbal communication

Team player

Familiarity with neurosurgical terms

Education

High School Diploma or equivalent

Job description

Full-Time | Insurance Authorization & Financial Clearance

Neurosciences and Spine Group is looking for a detail-oriented Pre-Cert Coordinator I to help ensure our patients' services are properly authorized and financially cleared before their visit. In this role, you'll verify insurance coverage, obtain authorizations, and communicate with payers and clinical staff to keep care on schedule.

Position Summary

Under general supervision, the Pre-Cert Coordinator I performs standardized authorization and financial clearance activities for our neurosurgery and spine practice, focusing on routine to moderately complex authorization tasks, payer communications, and documentation. This role follows established workflows and payer guidelines, escalating complex issues, denials, or exceptions to senior staff or leadership as needed. Because surgery dates, imaging, and procedures are often time-sensitive, this role requires close attention to timelines to avoid delays in patient care.

Requirements

• High School Diploma or equivalent required.
• Basic knowledge of prior authorization and insurance terminology preferred.
• Proficient with computers, online payer portals, and standard office applications.
• Strong attention to detail and ability to follow established procedures.
• Effective written and verbal communication skills.
• Cooperative, positive team player comfortable working within defined workflows.
• Familiarity with neurosurgical or spine-related procedures, imaging, and terminology preferred.

Essential Functions

• Verifies insurance eligibility and benefit coverage prior to scheduled services using our EHR and payer portals.
• Confirms active coverage dates, plan requirements, and authorization dependencies to ensure services are financially cleared.
• Performs eligibility rechecks as needed when service dates change or coverage requires validation.
• Identifies coverage or eligibility discrepancies and escalates per established workflows.
• Obtains initial insurance authorizations for neurosurgical and spine procedures, including surgeries, injections, and other interventional treatments, submitting requests via payer portals, fax, or phone.
• Obtains authorization for advanced imaging (MRI, CT) and diagnostic testing (e.g., EMG/NCS) ordered in support of neurosurgery and spine evaluations.
• Obtains authorization for durable medical equipment related to neurosurgery and spine care, such as braces and neurostimulators, when applicable.
• Enters authorization numbers and coverage details into the electronic health record.
• Reviews surgery and procedure schedules to confirm authorization coverage is secured well ahead of the scheduled date, prioritizing time-sensitive and urgent cases.
• Follows up on pending authorizations using established timelines, escalating urgent or approaching-deadline cases promptly.
• Documents payer determinations accurately and communicates authorization status to surgeons, clinical staff, and case management.
• Notifies leadership immediately of authorization delays or missing information that could impact a scheduled surgery or procedure.
• Works assigned work queues and portals under supervision, following departmental workflows and documentation standards.

Additional Responsibilities

• Maintains an initial prior authorization and eligibility denial rate below 7%.
• Prioritizes surgical and procedural authorizations to ensure approvals are completed well in advance of scheduled dates, protecting against day-of delays or cancellations.
• Escalates complex issues, denials, or exceptions to senior staff or leadership rather than handling independently.
• Requests guidance on nonstandard cases outside established payer rules and protocols.
• Performs other duties as assigned.

Why Join Neurosciences and Spine Group

• We're a collaborative, patient-first team that values dependability, flexibility, and genuine care for the people we serve. We invest in our staff through hands-on training, clear workflows, and a supportive care-team environment where your contributions are noticed.