Precertification Specialist

Bridgeview Eye Partners; Cuyahoga Falls (OH); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Paid holidays

PTO after 60 days

Health, dental, vision benefits

401k plan

Certification program advancement

Job summary

Davis Eye Center is seeking a detail-oriented Surgical Services Precertification Specialist to ensure timely, authorized surgical care. You will secure prior authorizations, verify coverage, and coordinate with surgeons, schedulers, clinics, and patients to obtain approvals before procedures.

Join a collaborative surgical services team focused on patient confidentiality, high-quality care, and streamlined workflows in a professional medical office setting.

Qualifications

• High school diploma or equivalent; associate degree preferred.
• Experience with insurance verification, prior authorizations, medical billing, or healthcare administration.
• Knowledge of CPT, ICD-10, and insurance processes.
• Strong attention to detail and organizational skills.
• Ability to prioritize multiple tasks in a fast-paced environment.
• Excellent verbal and written communication skills.
• Proficiency with EMR and Microsoft Office applications.
• Ability to work independently while collaborating with cross-functional teams.

Responsibilities

• Obtain insurance prior authorizations and precertifications for surgical procedures.
• Verify insurance benefits, eligibility, and coverage requirements.
• Review clinical documentation to ensure authorization requirements are met.
• Communicate with insurance carriers regarding authorization status and appeals.
• Coordinate with surgeons, surgery schedulers, clinics, and patients to obtain approvals before surgery.
• Maintain documentation in the electronic medical record and other systems.
• Monitor authorization expiration dates and renewals as needed.
• Resolve authorization denials and assist with appeals as appropriate.
• Stay current on payer guidelines, authorization requirements, and regulatory changes.
• Provide exceptional customer service while maintaining patient confidentiality and HIPAA compliance.

Skills

Insurance verification

Prior authorizations

Medical billing

Healthcare administration

HIPAA compliance

Attention to detail

Organizational skills

Verbal and written communication

Education

High school diploma or equivalent

Associate degree preferred

Tools

Electronic medical records

Microsoft Office

Job description

Surgical Services Precertification Specialist

Join Our Team!

At Davis Eye Center, our mission is to improve the lives of our patients through exceptional vision care. We’re looking for a detail-oriented, organized, and patient-focused Surgical Services Precertification Specialist to join our growing team. In this role, you’ll play a vital part in ensuring our patients receive timely surgical care by securing insurance authorizations and coordinating with providers, payers, and internal teams.

If you enjoy working behind the scenes to support outstanding patient care while collaborating with a dedicated surgical services team, we’d love to hear from you.

What We Offer

• 6.5 paid holidays per year
• PTO after the first 60 days of employment
• Full slate of benefits to include health, dental, vision, and 401k
• Growth and wage increase through company paid certification program

What You’ll Do

• Obtain insurance prior authorizations and precertifications for surgical procedures.
• Verify insurance benefits, eligibility, and coverage requirements.
• Review clinical documentation to ensure authorization requirements are met.
• Communicate with insurance carriers regarding authorization status and appeals.
• Coordinate with surgeons, surgery schedulers, clinics, and patients to ensure all required approvals are obtained prior to surgery.
• Maintain accurate documentation within the electronic medical record and other systems.
• Monitor authorization expiration dates and manage renewals when necessary.
• Resolve authorization denials and assist with appeals as appropriate.
• Stay current on payer guidelines, authorization requirements, and regulatory changes.
• Provide exceptional customer service while maintaining patient confidentiality and HIPAA compliance.

What We’re Looking For

• High school diploma or equivalent required; associate degree preferred.
• Previous experience with insurance verification, prior authorizations, medical billing, or healthcare administration preferred.
• Knowledge of medical terminology, CPT, ICD-10, and insurance processes preferred.
• Strong attention to detail and excellent organizational skills.
• Ability to prioritize multiple tasks in a fast-paced environment.
• Excellent verbal and written communication skills.
• Proficiency with electronic medical records and Microsoft Office applications.
• Ability to work independently while collaborating effectively with cross-functional teams.

PHYSICAL DEMANDS AND WORK ENVIRONMENT (per ADA Guidelines)

• Physical Activity: Standing, Walking, Stooping, Grasping, Typing, and Manual dexterity. The worker is required to have visual and verbal acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
• Physical Requirements: Must be able to lift up to 15 pounds on a regular basis from floor to waist, 5 pounds from waist to shoulder, and 5 pounds from shoulder to overhead.
• Work Environment: Professional medical office environment.

Make an Impact

Every successful surgery begins long before the patient enters the operating room. As a Surgical Services Precertification Specialist, you’ll help ensure our patients receive seamless, timely care while supporting our physicians and surgical teams every step of the way.