• 401(k) matching
• Dental insurance
• Health insurance
• Vision insurance
• 401(k)

Pre-Certification Specialist Job Description

•  Obtain prior authorizations and pre-certifications for medical procedures, diagnostic testing, imaging, medications, specialty services, and office-based procedures. 
•  Verify insurance eligibility, benefits, coverage limitations, and authorization requirements. 
•  Submit complete and accurate clinical information to insurance carriers to support medical necessity. 

•  Demonstrate preferred knowledge of spinal injections, joint injections, pain management procedures, neurology-related services, and associated payer requirements. 
•  Understand procedure-specific authorization guidelines and medical necessity criteria. 
•  Coordinate with providers and clinical staff regarding procedure scheduling pending authorization approval. 

•  Maintain working knowledge of CPT, ICD-10, and HCPCS coding, with preferred experience interpreting CPT codes related to spinal and joint injection procedures. 
•  Review physician orders, clinical documentation, and coding information to ensure authorization accuracy and completeness. 
•  Ensure all supporting medical records and documentation meet insurance and regulatory standards. 

•  Serve as a liaison between healthcare providers, insurance companies, patients, and clinical staff to facilitate efficient authorization processing. 
•  Communicate authorization statuses, denials, and additional documentation requirements to appropriate team members. 
•  Educate patients, when appropriate, regarding insurance authorization requirements and scheduling delays. 

•  Track and follow up on pending authorization requests to ensure timely approvals and avoid disruptions in patient care. 
•  Investigate, appeal, and assist in resolving denied or delayed authorization requests. 
•  Maintain detailed records of authorization statuses, reference numbers, and payer communications. 

•  Accurately enter and maintain authorization and pre-certification information within the Electronic Health Record (EHR) and other applicable systems. 
•  Maintain organized records of approvals, denials, expiration dates, and payer requirements. 

•  Stay current on insurance policies, payer updates, prior authorization requirements, and regulatory guidelines. 
•  Ensure compliance with HIPAA, payer regulations, and organizational policies and procedures. 

•  High School Diploma or equivalent required. 
•  Associate’s or Bachelor’s degree in Healthcare Administration, Medical Billing & Coding, Business Administration, or a related healthcare field preferred. 

•  Minimum of 2–3 years of experience in a healthcare, medical office, or insurance setting with a focus on prior authorizations, pre-certification, or insurance verification preferred. 
• Neurology, pain management, orthopedic, or specialty medical office experience preferred.

•  Strong knowledge of insurance pre-certification, prior authorization, and payer requirements. 
• Preferred knowledge of spinal injections, joint injections, and specialty procedure authorization workflows. 
• Working knowledge of CPT, ICD-10, and HCPCS codes, with preference given to candidates familiar with injection-related CPT coding.
•  Strong attention to detail and organizational skills. 
•  Excellent communication and interpersonal skills. 
•  Proficiency in Electronic Health Records (EHR) and medical office software. 
•  Ability to multitask, prioritize, and work independently in a fast-paced environment. 

• Certified Professional Coder (CPC) preferred but not required. 
•  Medical billing and coding certification is a plus. 

•  Competitive salary and benefits package 
•  Health, dental, and vision insurance 
•  Retirement savings plan with company match 
•  Opportunities for professional development and growth 
•  Supportive, team-oriented work environment