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Medical Precertification Jobs (NOW HIRING)

MUSC

Lead Precertification Specialist

Charleston, SC · On-site

Entity Medical University Hospital Authority (MUHA) Worker Type Employee Worker Sub-Type​ Regular Cost Center CC002349 CHSCorp - Precertification Unit Pay Rate Type Hourly Pay Grade Health-20 ...

Mercyhealth

$17.57 - $26.36/hr

... acquire precertification. * Contacts insurance companies or employer groups to obtain pre ... One year of pre-certifications, medical billing, registration, healthcare experience, or other ...

Mercyhealth

Precertification Specialist

Lake Geneva, WI · On-site

$17.57 - $26.36/hr

... acquire precertification. * Contacts insurance companies or employer groups to obtain pre ... One year of pre-certifications, medical billing, registration, healthcare experience, or other ...

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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 Jun 11, 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 June 2026, with employment types broken down into 2% Locum Tenens, 96% Part Time, and 2% Nights. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $95,625 per year, or $46 per hour.
Precertification/Insurance Verification Team Member | Part-Time, Day Shift

Precertification/Insurance Verification Team Member | Part-Time, Day Shift

Phelps Health

Phelps, NY • On-site

$17.50 - $21.50/hr

Part-time

Posted 7 days ago

Phelps Health rating

6.5

Company rating: 6.5 out of 10

Based on 35 frontline employees who took The Breakroom Quiz

591st of 870 rated healthcare providers

Job description

Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri.

No matter where you start with us, we're committed to taking our team to the top. If you're ready for the challenge of providing life-saving care or supporting those who do, read on to find your fit in the Phelps Health family.

General Summary

  • The Insurance Verification/Prior Authorization Team Member is responsible for verifying patient eligibility, determining benefits, and to obtain insurance prior authorization prior to patient's exam date and time.

Essential Duties and Responsibilities

  • Obtains or assists in obtaining prior authorization/precertification from insurance payers for surgical, laboratory, and diagnostic imaging procedures scheduled to be performed.
  • Processes multiple patient prior authorization/precertification requests at any given time in an efficient and accurate manner. Documents prior authorization/precertification decisions following clinical policy in clinical software.
  • Makes and receives calls on the status of authorizations and verifies benefits over the phone and/or via insurance payer websites.
  • Confirms member Plan eligibility and benefits prior to processing a request for pre-certification. Utilizes clinical knowledge, clinical resources or clinical policy as required.

Education

  • High school diploma or equivalent required.
  • Graduate of a Registered Medical Assistant or Licensed Practice Nurse program preferred.


Work Experience

  • Minimum 1 year of clinical experience in a health care organization required. Experience in insurance verification and prior authorization process preferred. Knowledge of Medical terminology and CPT & ICD-9/10 codes preferred.

Mental/Physical Requirements

  • Ability to receive and express detailed information through oral communications, visual acuity, and the ability to read and understand written directions. Normal mental concentration with repetitive operations for a long period of time. Communicates well both verbally and in writing, creates accurate and punctual reports, shares information and ideas with others, has good listening skills. Ability to stand, walk, sit, and reach.


Working Conditions

  • Standard office conditions with more than average noise. Periodic contact with conditions such as fumes, noise, chemicals, hazards, and/or diseases.

At Phelps Health, we think we have a better team, benefits, and opportunities for growth than anyone else around, and we invite you to see for yourself! Apply now to join us on our mission in health care.

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