Pre-Certification Specialist

Pre-Certification Specialist

Join to apply for the Pre-Certification Specialist role at Southwoods Health

Southwoods Health is hiring a Pre-Certification Specialist to work in our Authorizations Department in Boardman. The Pre-Certification Specialist will request and obtain authorizations for procedures and imaging ordered by Southwoods Health physicians.

• Respond promptly to referral source requests for information, supporting documentation, or other report needs
• Obtain accurate and detailed information to begin investigating sources for payment and gather patient information
• Obtain authorization from payer sources to begin services
• Assist in resolving insurance issues, re-authorization, and eligibility issues
• Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements
• Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed
• Facilitate follow-up regarding ongoing services, eligibility, and authorization
• Communicate payer verification or benefit issues
• Record insurance information to maintain data and communicate insurance information to pertinent staff
• Maintain confidentiality of patient information
• Independently maintain and work from the electronic medical record and additional databases
• Obtain pre-certification number from physician’s office if applicable
• Assist in the development, organization, and maintenance of role specific documents, policies, and tools
• Follow all federal, state, and regulatory guidelines to maintain compliance
• Ensure all processes at responsible physician practice maintains compliance with all regulatory agencies
• Perform other duties as assigned

• Training or courses in business office activities, computer skills, and medical terminology
• Effective communication skills, ability to problem solve, and great attention to detail
• Insurance Verification experience
• Minimum of 2 years’ experience pre-authorizing medical procedure and imaging exams across modality and specialty (FP or IM office experience a plus)

Full-time. Monday-Friday 8:30am-5:00pm.

At Southwoods, it's not just about the treatment, but how you're treated.