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Medical Precertification Specialist Jobs (NOW HIRING)

Davis Eye Center

Precertification Specialist

Cuyahoga Falls, OH · On-site

$15.25 - $18.75/hr

Surgical Services Precertification Specialist Join Our Team! At Davis Eye Center, our mission is to ... Maintain accurate documentation within the electronic medical record and other systems. * Monitor ...

Davis Eye Center

Precertification Specialist

Cuyahoga Falls, OH · On-site

$15.50 - $19.25/hr

Surgical Services Precertification Specialist Join Our Team! At Davis Eye Center, our mission is to ... Maintain accurate documentation within the electronic medical record and other systems. * Monitor ...

Addison Group

Precertification Specialist

Smyrna, GA · On-site

$22/hr

This position is eligible for medical, dental, vision, and 401(k) benefits. About the Opportunity ... Precertification Specialist for a contract-to-hire opportunity within its Revenue Cycle department.

Addison Group

Precertification Specialist

Smyrna, GA · On-site

$22/hr

This position is eligible for medical, dental, vision, and 401(k) benefits. About the Opportunity ... Precertification Specialist for a contract-to-hire opportunity within its Revenue Cycle department.

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How much do medical precertification specialist jobs pay per hour?

As of Aug 25, 2026, the average hourly pay for medical precertification specialist in the United States is $18.87, according to ZipRecruiter salary data. Most workers in this role earn between $16.35 and $20.19 per hour, depending on experience, location, and employer.

What is a medical precertification specialist?

A Medical Precertification Specialist is a healthcare professional responsible for obtaining approval from insurance companies before certain medical procedures, treatments, or hospital admissions can take place. They review medical documentation, communicate with providers and insurers, and ensure that all necessary authorizations are secured to avoid claim denials. Their work helps patients receive timely care while ensuring that healthcare providers are reimbursed appropriately. This role requires strong organizational, communication, and knowledge of insurance policies and medical terminology.

What are the key skills and qualifications needed to thrive as a medical precertification specialist?

To thrive as a Medical Precertification Specialist, you need a solid understanding of medical terminology, insurance guidelines, and healthcare procedures, often supported by a high school diploma or associate degree and relevant experience. Familiarity with electronic health records (EHR) systems and insurance verification software is typically required, and some employers may prefer certification such as Certified Medical Administrative Assistant (CMAA). Attention to detail, strong organizational abilities, and effective communication are crucial soft skills in this role. These skills ensure accurate authorization of procedures, reduce claim denials, and facilitate seamless coordination between providers, insurers, and patients.

What are some common challenges faced by medical precertification specialists when obtaining insurance authorizations, and how can they be addressed?

Medical Precertification Specialists often encounter challenges such as navigating varying insurance requirements, dealing with incomplete clinical documentation, and managing tight turnaround times for authorizations. To overcome these obstacles, specialists must stay updated on payer guidelines, maintain clear communication with healthcare providers, and develop strong organizational skills to track multiple requests simultaneously. Building collaborative relationships with clinical and insurance teams can also help streamline the precertification process and ensure timely approvals.

What is the difference between Medical Precertification Specialist vs Medical Claims Processor?

AspectMedical Precertification SpecialistMedical Claims Processor
CredentialsKnowledge of insurance policies, certifications may include medical billing or codingTypically requires medical billing or coding certifications
Work EnvironmentHealthcare offices, insurance companies, hospitalsHospitals, clinics, insurance companies
Job FocusReviewing and obtaining prior approvals for proceduresProcessing and coding insurance claims after services are rendered

The Medical Precertification Specialist primarily focuses on obtaining prior approvals for medical procedures, ensuring coverage before services are provided. In contrast, the Medical Claims Processor handles the post-service billing and claims submission process. While both roles require knowledge of insurance policies and medical billing, their responsibilities and workflow differ significantly.

How do you become a medical precertification specialist?

To become a medical precertification specialist, candidates typically need a high school diploma or equivalent, along with experience in healthcare or insurance billing. Relevant skills include knowledge of medical terminology, insurance policies, and familiarity with healthcare management software; some roles may require certification such as the Certified Professional Coder (CPC) or similar credentials.

How much does a medical precertification specialist make?

A medical precertification specialist typically earns between $40,000 and $60,000 annually, depending on experience, location, and employer. The role often requires knowledge of insurance policies and medical billing systems, with certifications like the Certified Medical Reimbursement Specialist (CMRS) enhancing earning potential.
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Medical Precertification Specialist jobs near you
Infographic showing various Medical Precertification Specialist job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 14% Part Time, and 6% Contract. Highlights an 87% Physical, 1% Hybrid, and 12% Remote job distribution, with an average salary of $39,247 per year, or $18.9 per hour.

Precertification Specialist

Philadelphia, PA • On-site

The Emerson Group
See more jobs at The Emerson Groupexternal

$26/hr

Other

Re-posted 8 days ago

Job description

Precertification Specialist

Our award-winning medical practice client in Philadelphia is looking for a Precertification Specialist to join their team. The ideal candidate will have at least 1 year of experience with precertification. Candidates must have a good work history and are extremely detail oriented. The hours are 7am-5pm Mondays-Thursdays. Parking pass is also included. This is a Direct Hire position with hourly rate up to $26/hour with excellent benefits.

The Precertification Specialist is responsible for managing and processing prior authorization requests for biologic medications, ensuring timely and accurate approvals in compliance with payer guidelines and clinical protocols. This role requires a strong understanding of biologic therapies, insurance requirements, and healthcare workflows. The specialist works closely with Billing Director, providers, patients, insurance companies, and pharmacy teams to facilitate access to high-cost biologic treatments. Attention to detail, excellent communication skills, and the ability to navigate complex payer systems are essential.

Key Responsibilities:
  • Submit and track prior authorization requests for biologic medications.
  • Verify insurance benefits and eligibility for specialty therapies.
  • Collaborate with providers to obtain necessary clinical documentation.
  • Communicate with payers to resolve issues and expedite approvals.
  • Educate patients on authorization status and next steps.
  • Maintain accurate records in payer portals.
  • Stay updated on payer policies and biologic drug changes.
  • Enroll patients in co-pay assistance programs.
  • Enter Biologic Charges.
  • Run Monthly Reports
  • Follow-up on denied biologic claims.
  • Non-biologic billing tasks as needed.
Key Performance Metrics:
  • Authorization Turnaround Time: Average time from submission to approval.
  • Approval Rate: Percentage of biologic precertifications approved on first submission.
  • Denial Resolution Rate: Success rate of overturned denials through appeals.
  • Documentation Accuracy: Percentage of submissions with complete and correct documentation.
  • Patient Communication Timeliness: Time taken to notify patients of authorization status.
  • Compliance Rate: Adherence to payer-specific guidelines and internal protocols.
  • Volume Management: Number of precertification cases handled per week/month.
Qualifications:
  • Experience in precertification or prior authorization
  • Knowledge of commercial insurance plans.
  • Familiarity with specialty pharmacy workflows and biologic drug therapies.
  • Strong organizational and communication skills.
  • Proficiency in payer portals.
  • Ability to work independently and collaboratively.

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