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Medical Precertification Jobs (NOW HIRING)

Temple University

Precertification Rep

Philadelphia, PA · On-site

$40K - $55K/yr

... precertification/authorization from all necessary payers to avoid delays in treatment/payment ... boundaries of medical science, and educating future healthcare professionals. Temple Health ...

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Medical Precertification information

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$45K

$95.6K

$180K

How much do medical precertification jobs pay per year?

As of Jul 22, 2026, the average yearly pay for medical precertification in the United States is $95,625.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,000.00 and $122,500.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Medical Precertification Specialist, and why are they important?

To thrive as a Medical Precertification Specialist, you need strong knowledge of medical terminology, insurance guidelines, and healthcare documentation, usually supported by experience in medical billing or coding. Familiarity with precertification software, electronic health records (EHR) systems, and payer-specific portals is typically required. Attention to detail, effective communication, and problem-solving skills help navigate complex cases and coordinate with providers and insurers. These skills ensure timely authorization of procedures, reduce claim denials, and support efficient patient care delivery.

What are some common challenges faced by professionals in Medical Precertification, and how can they be managed?

Professionals in Medical Precertification often encounter challenges such as managing high volumes of authorization requests, staying updated with ever-changing insurance policies, and communicating effectively with both healthcare providers and insurance payers. To address these, strong organizational skills and attention to detail are essential, as well as ongoing training on policy updates. Building collaborative relationships with clinical staff and maintaining clear documentation can greatly help in streamlining the approval process and reducing errors.

What is medical precertification?

Medical precertification is the process of obtaining approval from a health insurance company before a patient receives certain medical services, procedures, or medications. This process ensures that the proposed care is medically necessary and covered under the patient's insurance plan. Without precertification, insurance may deny payment for the service, leaving the patient responsible for the full cost. Medical precertification is typically handled by healthcare providers or specialists who communicate with insurance companies on behalf of patients. It helps control healthcare costs and ensures appropriate use of medical resources.

What is the difference between Medical Precertification vs Medical Billing Specialist?

AspectMedical PrecertificationMedical Billing Specialist
CredentialsOften requires knowledge of insurance policies and certifications in healthcare administrationTypically requires coding certifications and billing training
Work EnvironmentHealthcare facilities, insurance companies, or third-party payersMedical offices, hospitals, or billing companies
Primary ResponsibilitiesObtaining prior approvals for procedures and treatmentsProcessing claims, coding, and billing patients and insurers

Medical Precertification focuses on securing approval for medical procedures before treatment, while Medical Billing Specialists handle the financial aspects after services are provided. Both roles are essential in healthcare administration but serve different stages of patient care and reimbursement processes.

More about Medical Precertification jobs
What states have the most Medical Precertification jobs? States with the most job openings for Medical Precertification jobs include:
What job categories do people searching Medical Precertification jobs look for? The top searched job categories for Medical Precertification jobs are:
Medical Precertification jobs near you
Infographic showing various Medical Precertification job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 78% Full Time, 14% Part Time, and 7% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $95,625 per year, or $46 per hour.
Medical Precertification Specialist

Medical Precertification Specialist

Oneoncology

San Antonio, TX

Full-time

Posted 11 hours ago

Job description

Why Join Us?

The START Center is growing! We are pioneering premier Cancer Care for our patients with leading doctors, advanced diagnostics and cutting-edge therapies. We offer competitive wages, benefits, and yearly bonus opportunities. The growth of our organization and ourinnovative environment to treat and care for patients that have cancer make us a great match for anyone looking tobegin or further theircareer at a company with a mission thattruly impacts lives.

Job Description:

Medical Precertification Specialist - LVN plays a vital role in ensuring timely and accurate authorization of medical services, medications, and treatments, particularly within the oncology field. This position requires specialized knowledge of oncology treatment protocols, medications, and insurance requirements, enabling efficient coordination between healthcare providers, insurance carriers, and patients.

The ideal candidate brings clinical expertise, including prior experience with medication authorization processes, and a commitment to supporting oncology patients in accessing necessary care.

Key Responsibilities

Precertification and Authorization

  • Evaluate requests for medical services, medications, and treatments, with a focus on oncology therapies, to ensure compliance with clinical guidelines and insurance requirements.
  • Manage the authorization process for high-cost medications, chemotherapy regimens, and supportive treatments.
  • Liaise with insurance companies to secure prior authorizations and resolve coverage issues.

Clinical Review and Documentation

  • Analyze clinical records and treatment plans to determine medical necessity and appropriateness of care.
  • Ensure all approvals, denials, and related details are accurately documented in the electronic medical record (EMR) system.
  • Utilize knowledge of oncology medications and treatment protocols to support clinical review processes.

Communication and Coordination

  • Serve as the primary point of contact between healthcare providers, insurance carriers, and patients for authorization-related matters.
  • Provide clear and compassionate communication to patients regarding insurance coverage and authorization status.
  • Collaborate with oncology care teams to ensure continuity of care and timely initiation of treatment.

Compliance and Updates

  • Maintain compliance with HIPAA and other regulatory standards.
  • Stay informed about updates to oncology treatment guidelines, insurance policies, and coding standards (CPT/ICD-10).
  • Monitor changes in medication coverage policies, particularly for oncology drugs and supportive care products.

Team Collaboration

  • Partner with the oncology care team, pharmacy, billing, and scheduling departments to ensure seamless coordination of care.
  • Contribute to process improvement initiatives within the precertification and authorization workflow.

Qualifications

Licensure

  • Active and unrestricted LVN license

Experience

  • Minimum 1-2 years of clinical experience in a healthcare setting.
  • Preferred:
    • Previous experience with medication authorization, particularly for oncology treatments.
    • Familiarity with oncology treatment protocols and medications, including chemotherapy, immunotherapy, and supportive medications.

Knowledge

  • Strong understanding of medical terminology, oncology-specific treatments, and coding (CPT, ICD-10).
  • Comprehensive knowledge of insurance requirements for oncology medications and procedures.

Skills

  • Excellent analytical and problem-solving skills.
  • Proficiency in electronic medical records (EMR) systems and Microsoft Office Suite.
  • Strong interpersonal and communication skills, with the ability to explain complex information to patients and providers.

Key Competencies

  • Exceptional attention to detail, particularly in clinical and administrative tasks.
  • Ability to manage multiple priorities in a fast-paced, oncology-focused environment.
  • Empathy and professionalism when dealing with patients undergoing cancer treatment.
  • Commitment to continuous learning and staying updated on oncology advances and payer policies.

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