Pre-Certification & Prior Authorization Specialist
Primary Responsibilities – Pre-Certification Department
- Review medical chart documentation to ensure patient cases meet payer-specific medical policy guidelines for prior authorization.
- Prioritize incoming authorization requests based on urgency and medical necessity.
- Secure prior authorizations through payer websites or by phone; perform regular follow-up on pending cases.
- Maintain comprehensive and up-to-date payer files, including documentation of authorization requirements and guidelines.
Secondary Responsibilities – Billing Office
- Verify patient eligibility and confirm the practice’s participation with insurance payers.
- Provide front desk coverage on days when patients are seen in-office, including check-in/check-out and answering phones as needed.
Required Skills and Qualifications
- Proficient in the use of CPT and ICD-10 coding systems.
- Strong computer proficiency, including use of Microsoft Excel, Word, and internet-based applications.
- Exceptional attention to detail and above-average organizational skills.
- Ability to meet deadlines and manage a high-volume, time-sensitive workload.
- Excellent verbal and written communication skills; able to provide high-level customer service to patients, physicians, and insurance representatives.
- Demonstrated ability to multitask, prioritize, and maintain focus under pressure.