Precertification Operations Leader

Jobtailor; Kentucky; On-site; USD 60,000 - 95,000; Full time

Job summary

Jobtailor is seeking a precertification manager to lead the daily operations of the precertification department and to hire, train, and develop staff. The role focuses on securing complex pre-authorizations, applying medical necessity guidelines, and coordinating with clinical teams to support patient care.

You will become the go-to expert on insurance carriers and governmental payers, ensuring accurate information and smooth workflows across scheduling, eligibility, and documentation systems.

Qualifications

• Bachelor's degree or equivalent experience.
• 3 years of relevant experience required.
• 4–8 years of relevant experience preferred.
• Experience with Windows, Excel, and intranet/internet navigation tools preferred.
• Medical terminology, coding, and third-party reimbursement experience preferred.
• Ability to work in multiple systems for assigned tasks, management, and reporting.
• Strong problem-solving and presentation skills.
• High level of customer service skills.
• Ability to prioritize and coordinate multiple tasks in a busy environment.
• Clinical knowledge to interpret and apply medical necessity guidelines.
• Ability to use electronic medical records, scheduling and registration systems, ABN, eligibility, and document management software.

Responsibilities

• Implement and support OSUWMC's mission, values, standards, policies, and procedures
• Lead daily operational workflow for the precertification department
• Hire new staff and complete scorecards, performance reviews, and corrective action as needed
• Oversee training and onboarding of new team members
• Lead multidisciplinary efforts to secure complex pre-authorizations and prevent or appeal clinical denials
• Interpret and apply medical necessity guidelines to determine appropriate services
• Become a subject matter expert for insurance carriers and governmental payers
• Provide accurate, up-to-date insurance benefits and authorization information to clinical staff and patients
• Ensure accurate appointment, demographic, and insurance information is gathered
• Support physicians and customers by coordinating requests and resolving routine and complex problems
• Communicate regularly with clinical teams, medical staff, and other team members
• Determine the most appropriate communication method for obtaining authorizations
• Use electronic transactions, web portals, phone calls, and faxes to obtain authorizations

Skills

Precertification Management

Medical Necessity Guidelines

Insurance Authorization Processes

Customer Service Skills

Team Leadership

Education

Bachelor's degree or equivalent experience

Tools

Windows

Excel

Intranet Navigation

Web Portals

Electronic Medical Records

Scheduling Systems

Document Management Software

Data Management

Performance Reviews

Presentation Skills

Job description

Jobtailor is seeking a precertification manager to lead the daily operations of the precertification department and to hire, train, and develop staff. The role focuses on securing complex pre-authorizations, applying medical necessity guidelines, and coordinating with clinical teams to support patient care.

You will become the go-to expert on insurance carriers and governmental payers, ensuring accurate information and smooth workflows across scheduling, eligibility, and documentation systems.