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Insurance Precertification Jobs in New York (NOW HIRING)

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Insurance Precertification information

What is insurance precertification?

Insurance precertification is the process of obtaining approval from a health insurance company before a patient receives certain medical procedures, tests, or medications. This step ensures that the insurance provider agrees the proposed service is medically necessary and will be covered under the patient’s plan. Without precertification, an insurance company may deny payment for the service, leaving the patient responsible for the full cost. The process typically involves submitting clinical information and documentation to justify the need for the service. Precertification helps manage healthcare costs and ensures appropriate care from the start.

What are the key skills and qualifications needed to thrive in Insurance Precertification, and why are they important?

Success in Insurance Precertification requires knowledge of medical terminology, insurance policies, and healthcare procedures, often supported by experience in medical billing or coding. Familiarity with precertification software systems, electronic health records (EHRs), and payer portals is typically necessary. Strong attention to detail, organizational skills, and effective communication are vital soft skills for managing complex cases and collaborating with providers and insurers. These skills ensure timely and accurate insurance approvals, minimize claim denials, and support smooth patient care operations.

What is the difference between Insurance Precertification vs Insurance Authorization?

AspectInsurance PrecertificationInsurance Authorization
DefinitionProcess of obtaining prior approval from an insurer before certain services or proceduresGeneral approval from an insurer for coverage of services, often after services are rendered
TimingBefore the service or procedureUsually after the service has been provided
Required CredentialsTypically performed by insurance specialists or case managersHandled by insurance representatives or healthcare providers
Work EnvironmentInsurance companies, healthcare facilities, or third-party vendorsHospitals, clinics, or healthcare provider offices

Insurance Precertification involves obtaining prior approval before a procedure, while Insurance Authorization generally refers to approval after services are provided. Both are essential for insurance coverage but serve different stages in the approval process.

What are some common challenges faced in an Insurance Precertification role, and how can they be managed?

One common challenge in Insurance Precertification is navigating varying requirements and policies across different insurance providers, which can lead to delays or denials if not handled accurately. Staying organized, maintaining up-to-date knowledge of payer guidelines, and developing strong communication skills are essential for efficiently securing approvals. Collaborating closely with healthcare providers and insurance representatives can also help resolve issues quickly and ensure the best outcomes for patients. Many teams use specialized software systems to track requests and streamline the process, which can significantly reduce administrative burdens.
What are popular job titles related to Insurance Precertification jobs in New York? For Insurance Precertification jobs in New York, the most frequently searched job titles are:
What job categories do people searching Insurance Precertification jobs in New York look for? The top searched job categories for Insurance Precertification jobs in New York are:
Insurance Precertification jobs near you
Infographic showing various Insurance Precertification job openings in New York as of July 2026, with employment types broken down into 1% As Needed, 73% Full Time, 21% Part Time, and 5% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution.
Surgical Coordinator - Hybrid

Surgical Coordinator - Hybrid

ReFocus Eye Health

Manhattan, NY • On-site

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Job Type
Full-time
Description
Essential Duties and Responsibilities include the following: (Other duties may be assigned.)
  • Travels to Omni Eye Services locations as needed.
  • Follows all COVID guidelines provided by the practice.
  • Responsible for completing scheduling for all physicians either in person or over the phone according to guidelines; scheduling the procedure in all necessary systems, going over all surgical information with the patient including dates, location, paperwork, and requirements, scanning all surgical paperwork in all systems once completed in a timely manner, update surgical template with necessary information, update co-care information if applied and complete co-care information within the system, and email appropriate staff members with any updating information.
  • Responsible for completing the Check In process for assigned surgeon and submitting coding sheets to the Billing department through DM.
  • Creates surgical folders to be kept up to date and ready for use.
  • Collects payment for all elective and selfpay patients and send receipts to appropriate staff.
  • Scans and files all patient documents accumulated daily in DM by the end of each business day.
  • Retrieves messages from Patient Services and Surgical voicemail and contacts them back in a timely manner. Updates Telephone Call Templates in EHR with responses and generates document when completed.
  • Answers incoming calls and emails and responds to inquiry in a timely manner or directs to appropriate personal.
  • Documents and records all phone calls, fax submissions, incoming mail, and patient interactions that require the assistance of personnel or other department for communication purposes.
  • Verifies surgical benefits for physician and ESSI (if needed) and contacts patients regarding copayments, co-insurance, and deductible information. Enters information in PM system accurately and in a timely manner.
  • Ensures patient referral source and co-care information is kept abreast of patient care by entering or submitting all new referring physicians to the Referral Management Department for entry in the provider database or attaching updated physician's contact information to the patients' electronic chart in all designated areas.
  • Submits patients referred VIA fax/ Referring OD to the Referral Management Department. All scheduled patients must have their referral letters scanned into DM and noted in the system.
  • Sorts mail and handles fax requests.
  • Greets and directs patients, salespeople, and visitors.
  • Contacts patients to confirm upcoming surgical procedure and goes over all necessary requirements and questions.
  • Forwards on demand precertification and insurance verification requests to appropriate personnel.
  • Maintains and controls the release of information to authorized persons only.
  • Maintains a neat and orderly work area.
  • Orders, receives, and maintains office supplies and other surgical supplies such as folders and paperwork.

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