Pre-Certification Specialist

Socket.dev; Baton Rouge (LA); On-site; USD 33,000 - 42,000; Full time

Benefits offered by this job

Health insurance

401(k)

Paid time off

Job summary

Louisiana Women’s Healthcare in Baton Rouge seeks a full-time Pre-Certification Specialist to support a high-volume obstetrics clinic. This role obtains insurance benefits, verifies eligibility, and secures pre-authorizations for procedures, acting as liaison between providers, patients, and insurers.

The specialist ensures timely approvals, maintains documentation, and complies with HIPAA and payer policies.

Qualifications

• High school diploma or equivalent.
• Experience in a medical office or healthcare setting.
• Working knowledge of insurance authorization requirements and workflows.
• Understanding of HIPAA and strict adherence to patient confidentiality standards.
• Must demonstrate punctuality and reliable attendance.

Responsibilities

• Verifying insurance coverage and eligibility – Confirm patients’ insurance benefits and authorizations.
• Communication – Clarify coverage, authorization issues, and estimated amounts due with staff and patients.
• Obtain prior authorizations – Complete the authorization process with payers to ensure coverage.
• Maintain documentation – Keep accurate records of benefits and authorization status.
• Gather and submit documentation – Collect all required clinical and administrative information.
• Maintain compliance – Adhere to HIPAA and payer protocols to protect privacy.
• Follow up and resolve issues – Track authorization status and address denials.
• Benefits – ensure obstetrical patients and procedures have benefits completed and documented.
• System maintenance – Update insurance policy info and patient demographics as needed.

Skills

Compassion

Multitasking

Positive attitude

Team collaboration

Education

High school diploma or equivalent

Tools

Epic EMR

Job description

Description

Job Title: Pre-Certification Specialist

Employment Classification: Non-Exempt
Reports To: Manager, Pre-Certification

Schedule: Full-time | Monday–Thursday: 8:00 AM–4:30 PM | Friday: 8:00 AM–3:30 PM

Position Summary

Seeking a full-time Pre-Certification Specialist to support a high-volume OB‑GYN clinic. This position is responsible for obtaining insurance benefits, verifying eligibility, and securing pre‑authorizations for a wide range of procedures and services. The specialist serves as a key liaison between providers, patients, and insurance companies to ensure timely approvals and minimize delays in care.

Key Responsibilities

• Verifying insurance coverage and eligibility – Confirm patients’ insurance benefits, in‑network status, and any authorization requirements.
• Communication– Communicate with physicians’ staff, insurance representatives, and patients to clarify coverage, authorization issues, and estimated amount due.
• Obtain prior authorizations: Complete the authorization process with commercial payers, Medicare, Medicaid, and others to ensure coverage.
• Maintain documentation – Keep accurate records of benefits, patient information, and authorization status.
• Gather and submit documentation: Collect all required clinical and administrative information from referring physicians, patients, or third‑party facilities.
• Maintain compliance: Work within HIPAA and payer‑specific protocols to protect patient privacy and ensure regulatory compliance.
• Follow up and resolve issues: Track authorization status, and address denials.
• Benefits - ensure all new obstetrical patients, pre‑ops and office procedures scheduled have benefits completed, documented and provided to Patient Accounts.
• System maintenance – Update insurance policy information and/or patient demographics, in system when needed, to ensure proper processing.

Skills & Competencies

• Compassion and sensitivity to women’s health issues.
• Ability to multitask in a fast‑paced clinical environment.
• Positive attitude, reliability, and a strong work ethic.
• Team collaboration and adaptability.

Compensation & Benefits

We offer a comprehensive benefits package—including health insurance, 401(k), and paid time off—along with a competitive, market-based salary that reflects your experience.

Equal Opportunity Statement

Louisiana Women’s Healthcare is an equal opportunity employer and values diversity. All employment decisions are based on qualifications, merit, and business needs.

Disclaimer: This job description is not intended to provide a comprehensive list of all duties, responsibilities, or activities required of the employee. Duties may evolve, and new responsibilities may be assigned at any time, with or without prior notice.

Requirements

Required Qualifications

• High school diploma or equivalent.
• Previous experience in a medical office or healthcare setting.
• Working knowledge of insurance authorization requirements and workflows.
• Understanding of HIPAA and strict adherence to patient confidentiality standards.
• Must demonstrate punctuality and reliable attendance.

Preferred Qualifications

• Experience in an OB‑GYN or Family Practice setting preferred.
• Proficiency with EMR systems, Epic preferred.

Physical Requirements

• Ability to sit for extended periods while working at a computer.
• Occasional standing, walking, bending, or reaching within the office environment.
• Ability to lift and carry light items (typically up to 10–15 pounds), such as files or office supplies.