Job Title

Our client is seeking a Pre-Certification / Authorization Specialist to join their Medical Office. This role focuses on obtaining timely insurance authorizations and supporting the billing office with insurance verification and front desk duties. The ideal candidate is organized, detail-oriented, and has a strong understanding of CPT and ICD-10 coding.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.