Precertification & Insurance Verification Specialist

Northeast Georgia Health System; United States; On-site; USD 50,000 - 65,000; Full time

Job summary

Northeast Georgia Health System is seeking a detail-oriented Administrative & Clerical professional to manage pre-certifications and financial counseling for inpatient and outpatient services. You will verify insurance, obtain authorizations, and coordinate with physicians and payers to ensure timely admissions.

The role emphasizes strong problem solving, communication, and knowledge of insurance guidelines; it requires a high school diploma and may include AAPC/AHIMA/CPC credentials.

Qualifications

• High School Diploma or GED is required.
• Preferred credentials include AAPC, AHIMA or CPC certification.
• Experience with insurance authorization and precursor workflows is desirable.

Responsibilities

• Pre-authorize inpatient and outpatient accounts per guidelines.
• Submit clinical data supporting medical necessity for pre-certification.
• Collaborate with physicians, case management, and payers for data.
• Verify patient eligibility for hospital visits (inpatient and outpatient).
• Act as liaison among clinical staff, departments, patients, and payers.
• Document verification and authorization activities thoroughly.
• Monitor authorization issues and participate in process improvements.
• Meet customer service targets including call metrics and satisfaction.

Skills

Communication

Problem solving

Organizational skills

Protected Health Information

Medical terminology

Insurance guidelines

Payer information

Education

High School Diploma or GED

Job description

Northeast Georgia Health System is seeking a detail-oriented Administrative & Clerical professional to manage pre-certifications and financial counseling for inpatient and outpatient services. You will verify insurance, obtain authorizations, and coordinate with physicians and payers to ensure timely admissions.

The role emphasizes strong problem solving, communication, and knowledge of insurance guidelines; it requires a high school diploma and may include AAPC/AHIMA/CPC credentials.