Precertification & Authorization Lead (Healthcare)

Centers for Pain Control; Valparaiso (IN); On-site; USD 42,000 - 54,000; Full time

Job summary

Centers for Pain Control seeks a Precertification Specialist to manage precertifications, prior authorizations, and payer communications for outpatient procedures. You will extract medical information, verify eligibility, and ensure timely approvals.

The role requires experience with health insurance verifications, coding knowledge, and strong communication skills to navigate payer requirements and improve revenue cycle efficiency.

Qualifications

• Experience with health insurance verification, authorizations or referrals preferred.
• Knowledge of CPT, ICD-10-CM and HCPCS coding guidelines.
• Strong communication and organizational skills with attention to detail.

Responsibilities

• Prioritize and process incoming authorization requests and orders.
• Review clinical documentation to extract information supporting medical necessity.
• Obtain patient benefit and eligibility status for pending procedures.
• Communicate with payers and utilization management for favorable outcomes.
• Appeal denied authorizations when warranted and initiate peer reviews.

Skills

Electronic Medical Record

Typing

Internet navigation

Office equipment knowledge

Multi-line phone system

Medical terminology

CPT/ICD-10-CM/HCPCS coding

Communication

Organization

Tools

EMR software

Job description

Centers for Pain Control seeks a Precertification Specialist to manage precertifications, prior authorizations, and payer communications for outpatient procedures. You will extract medical information, verify eligibility, and ensure timely approvals.

The role requires experience with health insurance verifications, coding knowledge, and strong communication skills to navigate payer requirements and improve revenue cycle efficiency.