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Medical Insurance Pre-Certification Specialists

2 weeks ago

Fort Thomas, KY, United States ENT and Allergy Specialists Full time

Job Type

Full-time

Description

Job Summary:

We are seeking a detail-oriented and proactive Insurance Pre-Certification Specialist to join our team. This role is responsible for managing insurance pre-certifications, verifying patient benefits and deductibles, and ensuring timely follow-up to support surgical scheduling and billing accuracy.

Key Responsibilities:

  • Manage and follow up on all pre-admission and pre-certification processes for multiple provider and office locations.
  • Submit pre-certification requests via insurance portals (e.g., Humana, UnitedHealthcare) and through direct communication with insurance providers.
  • Verify and input accurate procedure codes to ensure correct pre-certification for scheduled surgeries.
  • Assess patient deductibles, including HSA accounts, and determine pre-surgical financial responsibilities.
  • Maintain organized and up-to-date records of all pre-certified cases, including necessary updates and changes.
  • Communicate regularly with insurance companies, patients, and internal staff to ensure timely approvals.
  • Send deductible letters and follow up on outstanding or pending cases.
  • Reprocess pre-certifications when surgical procedures differ from initial expectations.
Qualifications:
  • Proven experience in insurance pre-certification within a medical or surgical setting.
  • Strong understanding of medical billing and coding (CPT/ICD codes preferred).
  • Excellent organizational and multitasking skills.
  • Ability to work independently and collaboratively within a team.
  • Professional phone etiquette and effective communication skills (oral and written).
  • Familiarity with insurance providers and their authorization processes.
  • Proficiency in computer systems and electronic health records (EHR).
  • Associate degree or equivalent college coursework preferred.


Why Join Us?

Be part of a dedicated team in a fast-paced, patient-focused environment where your attention to detail and insurance expertise directly contribute to successful surgical outcomes and patient satisfaction.