The Pre-Certification Coordinator is responsible for coordinating the pre-authorization of medical and surgical services by working directly with third-party insurers. This remote position ensures that patient procedures are verified for coverage and that all required documentation is submitted promptly to support reimbursement.
Key Responsibilities
- Initiate and manage the pre-determination process for medical services, ensuring timely approvals.
- Contact insurance carriers to confirm patient benefits and secure pre-certification for both surgical and non-surgical procedures.
- Coordinate with financial counselors when pre-payment is needed for services not yet coded.
- Submit all necessary paperwork to insurance providers during the pre-certification phase.
- Maintain an up-to-date schedule of upcoming procedures and surgeries for department physicians, ensuring alignment with clinical teams.
- Keep a detailed written record of all active pre-certifications and inform hospital billing and utilization departments of approval status.
- Document receipt of pre-certification confirmations from payers.
- Perform additional administrative duties as needed to support operational efficiency.
Qualifications
A high school diploma or equivalent is required, along with at least two years of experience in a medical office environment. While not required, preferred candidates may hold an associate degree or have completed some college coursework. Certification as a Professional Coder (CPC) or as a Registered Health Information Technician (RHIT) is advantageous. Experience in medical coding, insurance verification, and managed care is highly valued. Strong organizational, interpersonal, and communication skills are essential for success in this role.
Work Environment
This is a remote position, offering flexibility while supporting a vital function within the Department of Medicine. The role requires consistent communication with internal providers and external insurance entities.
