Precertification & Prior Authorization Specialist

UofL Health; Louisville (KY); On-site; USD 42,000 - 54,000; Full time

Job summary

UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, and nearly 200 physician practice locations. The Precertification Specialist ensures timely prior authorizations, medical necessity determinations, and financial clearance for hospital and physician services across clinics and facilities.

With a focus on accurate documentation and efficient workflows, the role requires patient-focused communication, adherence to policies, and ongoing

Qualifications

• High School Diploma or equivalent required.
• At least 1 year of patient access, insurance verification, prior authorization, or related experience.
• Preferred: 3 years of prior authorization or related experience.
• Knowledge of EIPC.
• Medical terminology preferred.

Responsibilities

• Identify necessary clinical documentation to support medical necessity for scheduled procedures/medication orders.
• Submit authorizations and clinical information to payer in a timely fashion per plan rules.
• Assess orders to determine patient class and clarify with physicians as needed.
• Verify eligibility and coverage with insurance plans for procedures and benefits.
• Coordinate patient encounters across multiple systems and applications.
• Document all findings and communications in the patient record.

Skills

Patient access

Insurance verification

Prior authorization

Education

High School Diploma or equivalent

Tools

Electronic Health Record (EHR) systems

Job description

UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, and nearly 200 physician practice locations. The Precertification Specialist ensures timely prior authorizations, medical necessity determinations, and financial clearance for hospital and physician services across clinics and facilities.

With a focus on accurate documentation and efficient workflows, the role requires patient-focused communication, adherence to policies, and ongoing