Pre-Certification & Authorization Specialist

Med-Metrix; Aberdeen (WA); On-site; USD 42,000 - 64,000; Full time

Job summary

Med-Metrix is seeking a Pre-Certification Representative in the United States to obtain precertifications from insurance companies and input accurate patient data into our systems. The role requires healthcare experience, strong terminology knowledge, and proficiency with payer portals.

You will verify insurance details, communicate with physicians and patients, and ensure timely precertification before appointments, while maintaining HIPAA-compliant handling of PHI.

Qualifications

• Minimum 2–3 years in healthcare or physician's office related to pre-authorizations.

Responsibilities

• Obtain pre-certification from insurance companies for services.
• Place calls to health plans to obtain precertifications.
• Interpret clinical information and relay it to insurers accurately.
• Enter and update patient data in the scheduling/registration modules.
• Verify insurance information and document in host system.
• Review claim denials and rejections for resolution.
• Maintain confidentiality and HIPAA compliance at all times.

Skills

Healthcare experience

PHI & HIPAA

Medical terminology

Communication skills

Education

High School diploma

Tools

eviCore

Navinet

Novitasphere

GE Centricity / EPIC PB

Job description

Med-Metrix is seeking a Pre-Certification Representative in the United States to obtain precertifications from insurance companies and input accurate patient data into our systems. The role requires healthcare experience, strong terminology knowledge, and proficiency with payer portals.

You will verify insurance details, communicate with physicians and patients, and ensure timely precertification before appointments, while maintaining HIPAA-compliant handling of PHI.