Pre-Certification Coordinator

Job Summary

Managing complex pre-certifications for specialized services, the full-time remote Pre-Certification Coordinator will analyze therapy plans, verify insurance eligibility, and collaborate with clinical staff to resolve authorization issues.

Key responsibilities:

• Completes pre-certifications by analyzing therapy and treatment plans, drug protocols, and payer policies
• Verifies insurance eligibility and authorization information for existing pre-certifications
• Works with clinical staff to resolve add-ons, denials, and peer-to-peer requests in a timely manner

Required qualifications:

• High school diploma or equivalent certification
• Three years of experience in Clinical Office, Medical Billing, Health Information Management, or Pre-Certification
• Familiarity with EPIC and insurance pre-certification processes