Precertification Specialist II - Pre-Access - Days

The Precertification Specialist II is responsible for overseeing the completion of authorizations. The Specialist acts as the liaison between providers, physicians, insurance companies, billing department, and utilization review companies to ensure the initiation and/or completion of all payers requiring precertification.

Duties: 

• Monitors a listing of scheduled procedures to begin and complete the authorization process


• Reviews clinical records for supporting documentation and submits to obtain authorizations


• Documents accounts and charts with updated authorization statuses based on final payer responses


• Examines past procedures for performed testing with missing authorizations


• Submits clinical documentation for retroactive or upgraded authorizations


• Communicates with providers regarding incomplete documentation, peer-to-peer review requests, denials and appeals

Required Education: High School Diploma or GED equivalent. 

Required Experience: Minimum of two (2) years of experience with precertification and insurance verification in a hospital or healthcare setting OR completion of an LPN/RN program.