Precertification & Insurance Verification Pro

Northeast Georgia Health System; Gainesville (GA); On-site; USD 36,000 - 48,000; Full time

Job summary

Northeast Georgia Health System seeks an Insurance Verification/Pre-Certification Specialist to ensure timely pre-authorization for inpatient and outpatient services. You will verify insurance, collect patient information, and coordinate with physicians, case management, and payers to obtain approvals.

The role requires attention to detail, strong analytical and communication skills, and knowledge of payer guidelines. Excellent customer service is essential in a busy revenue-cycle environment.

Qualifications

• High School Diploma or GED is required.
• Preferred AAPC, AHIMA or CPC certification.
• 3–5 years of relevant experience in insurance authorization or related healthcare operations strongly preferred.
• Strong knowledge of payer requirements and insurance verification.

Responsibilities

• Pre-authorize inpatient and outpatient accounts per guidelines.
• Interpret clinical information to justify procedures for pre-certification.
• Collaborate with physicians, case management, and patients to obtain data.
• Verify patient insurance eligibility for visits.
• Communicate with payers to resolve authorizations delays or denials.
• Document verification and authorization activities thoroughly.
• Respond to calls and meet customer service standards.

Skills

Customer service

Communication

Problem solving

Analytical skills

PHI knowledge

Medical terminology

Insurance guidelines

Education

High School Diploma or GED

Job description

Northeast Georgia Health System seeks an Insurance Verification/Pre-Certification Specialist to ensure timely pre-authorization for inpatient and outpatient services. You will verify insurance, collect patient information, and coordinate with physicians, case management, and payers to obtain approvals.

The role requires attention to detail, strong analytical and communication skills, and knowledge of payer guidelines. Excellent customer service is essential in a busy revenue-cycle environment.