Job Description

Job title: Pre-Certification Specialist

Location (city, state): Houston, TX

Industry: Healthcare / Revenue Cycle / Prior Authorizations

Pay: $23–$24/hour

Benefits: This position is eligible for medical, dental, vision, life insurance and 401k.

About Our Client:

Addison Group is partnering with a healthcare organization seeking an experienced Pre-Certification Specialist with a strong background in prior authorizations. This position will focus heavily on obtaining authorizations for procedures and working directly with commercial payers to ensure services are approved prior to treatment.

Job Description:

The Precertification Specialist will manage high-volume prior authorization requests from start to finish. This includes reviewing clinical documentation, verifying benefits, submitting authorization requests, communicating directly with payers, and accurately documenting authorization information within client EMR systems.

Key Responsibilities:

• Obtain prior authorizations/precertifications for procedures and diagnostic services.
• Manage approximately 40+ authorization requests per day once fully trained.
• Verify patient insurance eligibility and benefits.
• Communicate directly with commercial payers regarding authorization requirements and status.
• Review clinical documentation and diagnosis codes to support authorization requests.
• Discuss clinical information with payers and respond to authorization-related questions.
• Enter and maintain authorization information within multiple client EMR systems.
• Track authorization requests through completion and follow up on outstanding items.
• Review EOBs and research discrepancies as needed.
• Pull information from EMR systems and maintain tracking information in Excel.

Requirements:

• 3+ years of recent strong prior authorization/precertification experience required.
• Must have experience obtaining authorizations for procedures.
• Strong understanding of the complete authorization process and payer follow-up.
• Experience reviewing clinical documentation and diagnosis codes.
• Must be comfortable discussing clinical information directly with insurance payers.
• Ability to read and understand EOBs.
• Experience entering authorization information into EMR systems.
• Professional or facility authorization experience accepted; facility experience preferred.
• Working knowledge of Excel.
• Strong research, critical thinking, and problem-solving skills.
• Ability to work independently and manage multiple systems simultaneously.

Additional Details:

• Hybrid schedule.
• First month of training is approximately 4 days onsite/1 day remote, Monday–Friday, 8:00 AM–5:00 PM.
  • After training, schedule transitions to approximately 3 days onsite/2 days remote.
• Flexible scheduling options available between 6:00 AM–6:00 PM after training.
• Fast-paced, high-volume environment.

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.  

#HC3

Job Tags

Similar Jobs