Preauthorization & Precertification Specialist I

MedStar Health; Maryland; On-site; USD 26,000 - 45,000; Full time

Job summary

MedStar Health is seeking a Preauthorization/Precertification Specialist to verify eligibility, obtain pre-authorizations, and ensure accurate data entry for billing prior to services.

The role focuses on radiology-related authorizations, communicating with payers and providers, and maintaining up-to-date knowledge of regulatory changes affecting pre-certification processes. Strong typing and system proficiency are essential.

Qualifications

• Requires working knowledge of payer authorization and clearance processes.
• Familiarity with UB04 HCFA 1500 or equivalent.
• Knowledge of CPT/ICD-10 coding.
• Excellent communication and organizational skills.
• Proficient in hospital registration and billing systems; MS Excel and Word.

Responsibilities

• Verify eligibility and pre-certification requirements for procedures.
• Obtain and enter pre-authorizations into the system and link to appointments.
• Communicate with payers, providers, and patients about authorizations.
• Enter data accurately in IDX, SMS/Invision, and other systems for billing.
• Monitor work queues and follow up to complete authorization requirements.

Skills

Payer authorization

Medical terminology

CPT/ICD-10 coding

Excel

Word

Billing systems

Typing 35 WPM

Education

High School Diploma

GED

Job description

MedStar Health is seeking a Preauthorization/Precertification Specialist to verify eligibility, obtain pre-authorizations, and ensure accurate data entry for billing prior to services.

The role focuses on radiology-related authorizations, communicating with payers and providers, and maintaining up-to-date knowledge of regulatory changes affecting pre-certification processes. Strong typing and system proficiency are essential.