Clinical Pre-Certification Support Specialist

Job Title:

Clinical Pre-Certification Support Specialist Location:

Boardman, OH Schedule:

Full-time, Monday-Friday About Southwoods Health:

At Southwoods, it's not just about the treatment, but how you're treated. We are a leading healthcare provider in northeast Ohio committed to personalized, top-quality care. Join our team and help us maintain the highest standards of medical expertise.

Position Summary:

The Clinical Pre-Certification Support Specialist assists our RN team by securing insurance authorizations for inpatient stays, procedures, medications, and imaging. You will act as a vital link between insurance payers and physician offices to ensure accurate billing and timely patient care.

Key Responsibilities:

Authorization Management:

Obtain, track, and extend clinical authorizations from various insurance carriers in a timely manner.

Verification:

Confirm that registration statuses and procedure codes (CPT) align with authorizations to ensure maximum reimbursement.

Clinical Review:

Assess medical necessity using patient history and insurance guidelines; handle urgent authorization requests as needed.

Problem Solving:

Resolve eligibility issues and communicate potential benefit or payer verification hurdles to pertinent staff.

Documentation:

Maintain accurate data within the Electronic Medical Record (EMR) and other databases while ensuring strict patient confidentiality.

Compliance:

Follow all federal, state, and regulatory guidelines.

Qualifications:

Experience:

Minimum of 2 years experience pre-authorizing inpatient stays and outpatient observations. Insurance verification experience is preferred.

Credentials:

Licensed LPN or Certified Medical Assistant preferred.

Skills:

Strong attention to detail, effective communication, and the ability to problem-solve.

Professionalism:

Must maintain high ethical standards and a professional demeanor at all times.

Apply Today:

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