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Pre-Certification Specialist
Job
Glen Rose Medical Center
Glen Rose, TX (In Person)
$36,400 Salary, Full-Time
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Job Description
Job Overview The Pre-Certification Specialist is responsible for obtaining prior authorizations and pre-certifications from insurance companies before medical services are rendered. This role ensures services are approved, verifies coverage, and helps prevent claim denials by confirming payer requirements in advance. Duties Obtain prior authorizations and pre-certifications from insurance carriers for scheduled procedures, treatments, and services Review patient information, medical records, and physician orders to ensure accuracy and completeness Verify insurance eligibility benefits , and coverage details Communicate with insurance companies via phone, online portals, or fax to secure approvals Ensure all required clinical documentation is submitted to support authorization requests Track Authorization status and follow up on pending requests Document authorization numbers, approval details, and expiration dates in patient records or EHR systems Notify clinical staff and scheduling teams of authorization approvals or denials Assist in appeals for denied authoriztions when necessary Stay current on payer guidelines, insurance requirements, and policy changes Maintain confidentiality and comply with HIPAA regulations Qualifications High school diploma or equivalent (Associate's or Bachelor's degree preferred) 1-3 years of experience in healthcare, insurance verification, or medical billing Knowledge of medical terminology, CPT/ICD codes, and insurance processes Experience working with electronic health records (EHR) systems Strong attention to detail and organization skills Excellent communication and customer service skills Ability to manage multiple tasks and prioritize workload effectively Preferred Skills Experience with prior authorization workflows Familiarity with Medicare, Medicaid, and commerical insurance plans Problem-solving and analytical skills Proficiency in Microsoft Office and healthcare software Work Environment Typically works in a healthcare setting such as a hospital, clinic, or physician's office May involve frequent phone and computer work Fast-paced environment with deadlines tied to patient scheduling