Pre-Certification Specialist

Southwoods Health; Boardman Township (OH); On-site; USD 42,000 - 56,000; Full time

Job summary

Southwoods Health in Boardman, Ohio, seeks a detail-oriented Pre-Certification Specialist to request and obtain insurance authorizations for procedures and imaging ordered by our physicians.

In this full-time on-site role, you will manage authorizations, verify patient data, and investigate payment sources while maintaining strict confidentiality and regulatory compliance. Join a collaborative team focused on patient care and operational excellence.

Qualifications

• Minimum of two (2) years of experience handling medical procedure and imaging pre-authorizations across multiple modalities and specialties.
• FP or IM office experience is highly preferred.
• Proven insurance verification expertise and meticulous attention to detail.
• Excellent interpersonal skills with a professional demeanor and strong ethics.

Responsibilities

• Request, track, obtain, and extend pre-authorizations from various insurance carriers in a timely manner.
• Gather accurate patient data and investigate alternative payment sources to initiate services.
• Assist in resolving complex insurance issues, re-authorizations, and eligibility discrepancies.
• Respond to referral sources with required documentation and medical reports.
• Maintain and update insurance details in EMR and internal databases for payer verifications.

Skills

Insurance verification

Problem solving

Attention to detail

Interpersonal skills

Education

Medical terminology training

Business office operations

Computer applications training

Job description

Location: Southwoods Executive Centre – Boardman, Ohio

About The Role

Southwoods Health is seeking a detail-oriented Pre-Certification Specialist to join our growing team at the Southwoods Executive Centre. In this role, you will be responsible for requesting and obtaining insurance authorizations for procedures and imaging ordered by Southwoods Health physicians.

Essential Duties & Responsibilities

• Authorization Management: Request, track, obtain, and extend pre-authorizations from various insurance carriers in a timely manner.
• Intake & Investigation: Gather accurate, detailed patient data and investigate alternative payment sources to initiate services.
• Issue Resolution: Assist in resolving complex insurance issues, re-authorizations, and patient eligibility discrepancies.
• Information Handling: Promptly respond to referral sources requesting supporting documentation, medical reports, or clinical information.
• Internal Communication: Record and update insurance details within internal databases to keep pertinent staff informed of payer verifications or benefit changes.
• Compliance & Confidentiality: Maintain strict patient confidentiality and adhere to all federal, state, and regulatory guidelines (including OSHA, ODH, BOP, and TJC) across physician practices.
• Data Management: Independently maintain records and workflow utilizing electronic medical records (EMR) and specialized databases.
• Administrative Support: Assist in the development, organization, and maintenance of role-specific documents, policies, and process tools.

Qualifications & Requirements

• Education/Training: Specialized courses or training in medical terminology, business office operations, and computer applications.
• Experience: Minimum of two (2) years of experience handling medical procedure and imaging pre-authorizations across multiple modalities and specialties. Family Practice (FP) or Internal Medicine (IM) office experience is highly preferred.
• Skills: Proven insurance verification expertise, strong problem-solving capabilities, and meticulous attention to detail.
• Communication: Excellent interpersonal skills with the ability to maintain a highly professional demeanor, strong ethical standards, and moral principles at all times.

Schedule: Full-time. Monday-Friday 7:30am-4:00pm.

At Southwoods Health, it's not just about the treatment, but how you're treated.