Pre-Certification Specialist

Paycom; Austin (TX); On-site; USD 42,000 - 62,000; Full time

Job summary

Paycom is seeking a Pre-Certification Specialist to manage precertification requests with insurance companies for appointments and procedures. You will coordinate with billing and office staff to ensure accurate data entry and financial responsibility documentation. The role requires knowledge of ICD-10, CPT-4 codes, and strong communication skills.

The position emphasizes timely coordination, attention to detail, and ability to multi-task in a fast-paced medical office environment.

Qualifications

• Education: High School diploma or GED.
• Experience: 2+ years of pre-certification experience required.
• Level I: 1-4 years with supervision; >4 years with more supervision.

Responsibilities

• Obtain all requests for precertification and prior authorization from insurance companies for appointments, scheduled tests and procedures.
• Contact insurance companies as needed to obtain precertification and record on form data entry.
• Communicates necessary patient financial information with appropriate office and billing personnel in an efficient, timely and accurate manner.
• Documents, within the practice management system, all required information to include financial responsibility.
• Verify waivers have been signed as needed for tests and procedures prior to date of service.
• Communicate with staff on any adjustments on precertification.
• Light data entry and other related office duties.
• Other duties as assigned.

Skills

Excellent communication

Medical terminology

ICD-10/CPT-4 knowledge

Computer skills

Multi-tasking/ prioritization

Self-motivation

Education

High School diploma or GED

Job description

Position purposeResponsible for the communicating with insurance companies to ensure proper certification/authorization is obtained prior to patient’s appointment and all scheduled tests and procedures.Responsibilities/Duties/Functions/Tasks:Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Obtain all requests for precertification and prior authorization from insurance companies for appointments, scheduled tests and procedures.Contact insurance companies as needed to obtain precertification and record on form data entry.Communicates necessary patient financial information with appropriate office and billing personnel in an efficient, timely and accurate manner.Documents, within the practice management system, all required information to include financial responsibility.Verify waivers have been signed as needed for tests and procedures prior to date of service.Communicate with staff on any adjustments on precertification.Light data entry and other related office duties.Other duties as assigned.QualificationsEducation: High School diploma or GED.Experience: Minimum of two (2) years of pre-certification experience required.Requirements for Level I Status:Entry level (1-4 years’ experience) and/or meet the basic requirements of the job with the need for additional supervision.Excess of 4 years’ experience if meeting only the basic requirements of the job with need for additional supervision.Additional Qualifications: Proficient knowledge of medical terminology, ICD-10 and CPT-4 codes.Performance Requirements:Excellent communication skills, both written and verbal.Proficient technical (computer) skills.Ability to multi-task and prioritize.Self-motivated with initiative.Strong sense of ethics.