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Medical Precertification Jobs (NOW HIRING)

Precertification Specialist

Janesville, WI ยท 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 Sep 2, 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 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 are the key skills and qualifications needed to thrive as a medical precertification specialist?

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 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:

Infographic showing various Medical Precertification job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $95,625 per year, or $46 per hour.

PRECERTIFICATION PRIOR AUTHORIZATION SPEC, GENERAL SURGERY

SGMC Health

Valdosta, GA โ€ข On-site

$32K - $45K/yr

Other

Medical, Life, Retirement, PTO

This job post hasย expired 2 days ago.ย Applications are no longer accepted.


Job description

Description
WHAT IT'S LIKE AT SGMC HEALTH
Purpose. No matter your role or area that you work in, at SGMC Health we are collectively working towards goals that will make our community a better place.
Excellence. We strive to do the right thing the right way, are accountable in all we do, require competence of our people, and are compassionate in our service.
Team Spirit. We encourage team effort, support personal and professional development, acknowledge individual talents and skills, and support innovation and empowerment.
Award Winning Performance. We are committed to providing the best care possible and we are proud to be recognized locally, statewide, and nationally for the exceptional care that our staff provides.
WHY YOU WILL LOVE SGMC HEALTH
SGMC has great benefit options, depending on the role that you are going into- including healthcare, supplementary benefits, ways to save for the future, opportunities for career advancement, and opportunities to expand your skill set. Some of these great benefit options are listed below:
  • Low Healthcare Insurance Premiums
  • 401(k) with employer match
  • Paid Time Off (PTO)
  • Employee discounts
  • Company paid life insurance
  • Short-Term and Long-Term Disability
  • Cancer Insurance
  • Accident Insurance
  • Pet Insurance
  • Tuition Reimbursement
  • On-the-job training and skills development
  • Opportunities for growth and advancement
  • Employee Assistance Program

JOB LOCATION : Professional Building
DEPARTMENT: SPN - GENERAL SURGERY
SCHEDULE: Full Time, 8 HR Day Shift, 8-5 M-Th, 8-12 Fri
POSITION SUMMARY
Responsible for obtaining precertification and/or prior authorization for each patient for which testing and/or procedures have been ordered by the Surgeon, prior to services being rendered, using appropriate diagnoses and procedure codes. The precertification and/or authorization must be obtained on each patient, preferably prior to their scheduled appointment. If not able to obtain precertification and/or authorization, specialist must contact the patient to reschedule their appointment. Responsible for reviewing for accuracy of information requested and received in regard to precertification and/or prior authorization numbers received, as well as supporting documents. Responsible for uploading into SGMC Health EHR software system, authorization numbers, time spans/number of procedures, etc. and supporting documentation upon verification that procedures are authorized as requested. Responsible for monitoring and tracking of authorization requests and expiring authorizations. Responsible for the use of and, documentation in, SGMC Health EHR software system as the official medical record, following appropriate guidelines for documenting. Responsible for contributing to department development. Perform front office reception and various customer service duties. Other duties as identified and assigned by Practice Manager.
KNOWLEDGE, SKILLS & ABILITIES
High school graduate preferred. Minimum (1) year prior administrative experience or equivalent; preferable in a hospital or medical office setting to include working knowledge of insurance and managed care. Must have excellent computer (technical and systems) skills & knowledge: PC and Windows literacy required, as well as Microsoft Office applications - Outlook, Word, Excel, etc. as well as a variety of other office machines. Prior use of medical office software database preferred. Must possess excellent communication and interpersonal skills and must be able work effectively as part of a team and respond well to supervision. Self-motivated, showing initiative to tackle important issues, problems and tasks. Attention to detail skills is critical; ability to manage multiple tasks, meet deadlines and be flexible in order to adapt to variety on the job; ability to cross train to other functions as necessary. Requires flexibility in work scheduled for accountability expectations for operations and process management in a customer focused business.
WORKING CONDITIONS - ADA INFORMATION
Generally regular work schedule during normal office hours. Comfortable setting indoors. May be subjected to high levels of stress. Must be able to sit for prolonged periods of time. Moderate heavy lifting (0-25 lbs.), reaching, stooping, pushing, pulling, bending and twisting. Must be able to operate office equipment to include FAX, copier, and computer.
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