Precertification Specialist- Retina

Paycom - ATS; Huntersville (NC); Hybrid; USD 42,000 - 64,000; Full time

Job summary

CEENTA is seeking a detail-oriented Precertification Specialist to support our Revenue Cycle team by verifying insurance benefits, obtaining prior authorizations, and ensuring patients are well informed prior to services. This remote/hybrid role requires accuracy in entering pre-payments and clear communication with patients and provider offices.

You will monitor work queues, follow payer guidelines, and escalate issues as needed to ensure services are authorized and financially cleared before

Qualifications

• High school diploma or GED required.
• Minimum of 2 years of experience in a medical field.
• At least 1 year of precertification or prior authorization experience preferred.
• Understanding of payer medical policies and prior authorization guidelines.
• Epic experience preferred but not required.

Responsibilities

• Verify and confirm patient insurance benefits via online portals and phone calls.
• Obtain prior authorizations and referrals as required by payer plans, with ongoing follow-up when needed.
• Communicate benefit details, coverage, and expected pre-payments clearly to patients.
• Communicate with provider offices and internal teams to resolve authorization and benefit issues.
• Enter patient pre-payments into Epic accurately and timely.
• Monitor emails, in-basket messages, voicemails, and scanned faxes daily.
• Identify potential systemic or payer-related issues and escalate them to leadership as appropriate.

Skills

Customer service

Communication

Attention to detail

Multitasking

Education

High school diploma or GED

Tools

Epic

Job description

Precertification SpecialistWhy Join CEENTA?CEENTA is the premier eye, ear, nose, and throat group in the Carolinas, committed to exceptional patient care, operational excellence, and a collaborative team environment.We are seeking a detail-oriented Precertification Specialist to support our Revenue Cycle team by verifying insurance benefits, obtaining prior authorizations, and ensuring patients are well informed prior to services.What You Will DoVerify and confirm patient insurance benefits via online portals and phone callsObtain prior authorizations and referrals as required by payer plans, with ongoing follow-up when neededCommunicate benefit details, coverage, and expected pre-payments clearly to patientsCommunicate with provider offices and internal teams to resolve authorization and benefit issuesEnter patient pre-payments into Epic accurately and timelyPrioritize assigned work queues by date of service, payer, and procedural requirementsMonitor emails, in-basket messages, voicemails, and scanned faxes dailyIdentify potential systemic or payer-related issues and escalate them to leadership as appropriateA Typical DayMonitor authorization and benefit verification work queues, contact payers, communicate with patients regarding pre-service payments, respond to emails and in-basket messages, process incoming faxes, and collaborate with provider offices to ensure all scheduled services are authorized and financially cleared prior to the date of service.ScheduleHybrid/Remote, Full-time, 40 hours per week. Monday–Friday with hours ranging between 7:00 a.m. and 6:00 p.m.Work EnvironmentRemote/Home Office environment. Employees must have a dedicated, HIPAA-compliant workspace with high-speed internet and sufficient space for two monitors. The ability to work independently, manage time effectively, and remain productive in a remote setting is required.TravelTravel is not required for this position, except for training or occasional in-person staff meetings as needed.What You'll BringHigh school diploma or GED requiredMinimum of 2 years of experience in a medical fieldAt least 1 year of precertification or prior authorization experience preferredUnderstanding of payer medical policies and prior authorization guidelinesStrong attention to detail and ability to manage a high-volume, time-sensitive workloadExcellent customer service and communication skillsAbility to multitask, problem-solve, and work independentlyEpic experience preferred but not required