Pre-Cert Specialist

Job Information

Job Title:

Precertification Specialist

Location:

Sandy Springs, GA (in-office, full time)
Pay: $25/hr
Job Type: Contract to hire

Hours:

Mon-Fri, 8-5 (some flexibility)

Handling pre‑authorizations for oncology procedures.

• Initiates verification of eligibility and plan benefits.
• Notifies and authorizes all outpatient accounts.
• Follows developed policies and procedures to obtain insurance benefits.
• Contacts third‑party payers to verify eligibility.
• Initiates pre‑authorization for out‑patient services.
• Identifies correct insurance plan, financial class, and coordination of benefits.
• Enters authorization documentation into appropriate systems.
• Responsible for obtaining clinical authorization by communicating patient and clinical information, medical necessity, and level of care to payers to secure account for reimbursement.

• High school diploma or equivalent.
• Knowledge of drug HCPCS and diagnosis codes.
• Ability to review physician notes in medical records.
• Knowledge of government, managed care, and commercial insurance payer requirements to obtain authorization for treatment.
• Typing skills and good communication skills.
• Must pass criminal background and drug test (including tobacco).