Pre-Certification & Insurance Authorization Specialist

Nebraska Spine Center LLP; Omaha (NE); On-site; USD 25,000 - 39,000; Full time

Job summary

Nebraska Spine Center LLP is seeking a Pre-Certification Specialist to support pre-authorizations for outpatient procedures and imaging in a busy medical office. This full‑time, on‑site role partners with physicians and the billing team to verify coverage and document determinations daily.

You'll communicate with payers and patients, ensure HIPAA-compliant handling of information, and maintain accurate records in the practice management system.

Qualifications

• 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 related healthcare business-office function preferred.

Responsibilities

• Pre-certification of outpatient procedures and imaging based on provider orders and payer criteria.
• Pre-certification of surgical procedures with documentation from ordering provider.
• Follow up on pending pre-certifications with insurance carriers within established turnaround times.
• Maintain working knowledge of CPT and ICD-10-CM coding conventions to support submissions; escalate questions.
• Answer patient calls and provide status updates while protecting PHI per HIPAA.
• Document all payer communications and determinations in the practice management system/EHR.
• Actions and decisions regarding medical necessity remain with ordering provider and payer reviewers.
• Assist scheduling for imaging, injections and surgical procedures; provide cross-coverage as needed.
• Duties may change over time as determined by supervisor.

Skills

Insurance terms

Medical terminology

CPT coding

ICD-10 codes

Verbal communication

Written communication

Telephone etiquette

Attention to detail

Education

High school diploma or equivalent

Job description

Nebraska Spine Center LLP is seeking a Pre-Certification Specialist to support pre-authorizations for outpatient procedures and imaging in a busy medical office. This full‑time, on‑site role partners with physicians and the billing team to verify coverage and document determinations daily.

You'll communicate with payers and patients, ensure HIPAA-compliant handling of information, and maintain accurate records in the practice management system.