The Pre-Certification Specialist is responsible for obtaining authorizations for ordered procedures, timely and accurately, to ensure reimbursement for outpatient services. The specialist is responsible for providing complete documentation of clinical information to payers in support of healthcare services to be authorized.

• Knowledge of participating insurances and authorization requirements.
• Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details.
• Ability to verify patient eligibility and precertification requirements through online resources or via telephone.
• Effectively communicate with families; when appropriate, regarding benefit details and limitations.
• Documents detailed communication with payors and clinical support in the authorization fields.
• Contacts family with any insurance issues that may prevent obtaining a referral/precertification.
• Timely management of incoming responses.
• Provide team coverage when needed.
• Other duties as assigned.

Requirements:

• High School graduate or equivalent

No experience is required, 1 to 3 years of experience is preferred as follows:

• Experience in processing prior-authorizations and referrals is preferred.
• Understands the concept of PCP and referrals protocols as defined by Insurance Carriers
• $19.00-$21.00