Precert Specialist - Pain Mgt

Medical Office Personnel with administrative responsibilities focus on obtaining pre-certifications and authorizations for procedures for our pain management physicians.  The candidate must be detail-oriented, focused, organized, and a team player with an attitude to contribute meaningfully to the practice.

• Contact insurance companies and other third-party payers to determine preauthorization requirements for diagnostic services.  

• Call insurance companies or use online tools to obtain preauthorization. Follows up timely and thoroughly.  

• Ensures all preauthorization issues are communicated in a timely manner.  

• Liaisons with the physician’s staff to obtain additional insurance and/or clinical information.  

• Reviews patients' charts and submits appropriate and pertinent information from the clinicals for medical necessity for the service.  

• Follows up properly on all denials and peer-to-peer requests.  

• Documents appropriately regarding all actions, authorization, and denials.  

• Able to prioritize, work accurately, work well independently, and able to maintain focus under pressure  

• Working knowledge of medical terminology, insurance packages/plans, and proficient with EMR  

• Clearly communicate with providers, insurance companies, and staff.  

• Excellent verbal and written communication skills  

• Excellent organizational skills, multi-tasking capabilities, and detail-oriented  

• Customer Services skills  

• Basic Computer/PC and Internet skills  

• Attention to detail and problem-solving skills  

• Must be a great team player  

• 1 year precertification experience (preferred) 

• Physical demands are light to moderate, involving prolonged sitting, repetitive hand motions, and occasional lifting of office materials.

• Work environment is fast-paced and office-based.