Precertification Specialist, Nucleus Building, 8a-430p

UofL Health, Inc.; Louisville (KY); On-site; USD 42,000 - 56,000; Full time

Job summary

UofL Health in Louisville, Kentucky is seeking a Precertification Specialist to support prior authorizations and medical necessity determinations for scheduled procedures and tests across multiple service lines.

You will verify eligibility, contact payers, and document communications in the patient record while maintaining HIPAA compliance and delivering a positive patient experience. This full-time role emphasizes accuracy, productivity, and timely updates to payers, physicians, and patients.

Qualifications

• High School Diploma or equivalent.
• At least one year of patient access, insurance verification, prior authorization, or related experience.
• Three years of prior authorization or related experience (preferred).

Responsibilities

• Identifies clinical documentation to support medical necessity for scheduled procedures and medications.
• Submits authorizations and information to payers in a timely fashion per plan rules.
• Verifies eligibility and coverage for procedures; coordinates patient encounters across multiple systems.
• Documents findings and communications in the patient record accurately and completely.
• Maintains HIPAA privacy and security standards while supporting a positive patient experience.

Skills

Patient access

Insurance verification

Prior authorization

Medical terminology

HIPAA compliance

Customer service

Education

High School Diploma

Tools

Electronic Health Record (EHR)

CMS IP Only list

EIPC knowledge

Job description

Precertification Specialist, Nucleus Building, 8a-430p# Careers## Precertification Specialist, Nucleus Building, 8a-430pApply: Louisville, Kentucky: Full time: Posted Today: JR 2026-110928# **Primary Location:**Nucleus Building - ULP - AMG# **Address:**300 E. Market St.Louisville, KY 40202# **Shift:**First Shift (United States of America)# **Job Description Summary:**UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehab Institute and Brown Cancer Center. With more than 12,000 team members—physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals—UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day. The Precertification Specialist sets the precedence to ensure a positive patient experience for upcoming surgical procedures and diagnostic tests by accurately and efficiently completing all necessary steps related to prior authorization, medical necessity determination and financial clearance for the hospital system and physician services for clinics, adult acute facilities and diagnostic centers.# **Job Description:**Accurately and efficiently identifies all appropriate and necessary clinical documentation to support medical necessity for all scheduled procedures/medication orders for multiple service lines and clinics. Submits authorizations and clinical information to the appropriate payer/benefit manager in a timely fashion in compliance with plan rules including appropriately utilizing the CMS IP Only list. Assesses orders to determine appropriate patient class and works with physicians to clarify as necessary Contacts insurance plan/payers to determine eligibility, coverage information for specific procedures and benefit information Coordinates patient encounters using multiple systems applications, various registration applications, clinical operating systems, eligibility verification systems and medical necessity applications. Documents all findings/communications thoroughly and accurately in the patient record. Meets or exceeds productivity standards in the completion of daily assignments and accurate production. Documents all authorization information accurately in the referral as necessary to produce a clean transaction with the payer. Answer and responds to all communications through multiple applications in a timely and professional manner to ensure a positive patient experience. Complies with all departmental and organizational policies and procedures. Complies with local, state, and federal rules and regulations and the requirements of accrediting bodies. Prioritizes work according to the department, hospital, and patient needs. Independently works to resolve patient and provider questions related to prior authorizations, referrals, and insurance verification. Acts as a liaison between the patient, payer, provider and clinical support staff. Responsible for managing/setting up peer to peers and/or appeals for providers in a timely and professional manner according to individual plan guidelines. Work with all necessary parties to ensure patients are rescheduled/ notified of denials promptly. Responsible for understanding and staying current and up to date on payer regulations. Accurately provide expected timeframes /payer guidelines to patients and providers regarding prior authorization/ financial clearance. Maintains compliance with all company policies, procedures and standards of conduct Complies with HIPAA privacy and security requirements to maintain confidentiality at all timesPerforms other duties as assigned# **Additional Job Description:**Education:High School Diploma or equivalent (required)Experience:At least one year of patient access, insurance verification, prior authorization, or related experience (required) 3 years of prior authorization or related experience (preferred) Medical Terminology preferredPreferred QualificationsHealthcare experience preferred. Electronic Health Record experience preferred. Knowledge of EIPC.