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Pre Certification Jobs (NOW HIRING)

Insight

Pre-Certification Specialist

Chicago, IL · On-site

$18 - $23/hr

The Pre-Certification Specialist is responsible for processing referrals for services and obtaining needed authorizations from the patient's payor source. This is to be done for both out-patient ...

Southwoods Health

Pre-Certification Specialist

Boardman, OH · On-site

$15 - $20/hr

Pre-Certification Specialist Company: Southwoods Health Position: Pre-Certification Specialist Location: Southwoods Executive Centre - Boardman, Ohio About the Role Southwoods Health is seeking a ...

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Pre Certification information

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$13

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How much do pre certification jobs pay per hour?

As of Jun 10, 2026, the average hourly pay for pre certification in the United States is $35.24, according to ZipRecruiter salary data. Most workers in this role earn between $22.60 and $43.75 per hour, depending on experience, location, and employer.

What is a Pre Certification specialist?

A Pre Certification specialist is a healthcare professional responsible for obtaining approval from insurance companies before certain medical procedures, treatments, or hospital admissions. Their job involves verifying patient insurance coverage, submitting necessary documentation, and communicating with both healthcare providers and insurers to ensure services are authorized. This process helps prevent unexpected costs for patients and ensures compliance with insurance requirements. Pre Certification specialists play a crucial role in streamlining patient care and reducing claim denials.

What is the difference between Pre Certification vs Certified Technician?

AspectPre CertificationCertified Technician
Required CredentialsTypically no formal certification required, often an entry-level or preparatory statusRequires specific certifications or licenses, demonstrating proficiency
Work EnvironmentTraining settings, entry-level roles, or preparatory stagesActive work in the field, performing technical tasks
Employer UsageUsed to indicate readiness for certification or entry-level statusIndicates a qualified professional with verified skills

Pre Certification generally refers to an initial or preparatory status before obtaining full certification. Certified Technician signifies a professional who has met certification requirements and is qualified to perform technical tasks independently. The main difference lies in certification status and work readiness, with Pre Certification serving as a stepping stone towards full certification.

What are pre-certifications?

Pre-certifications are approvals required before certain healthcare services or procedures can be performed, ensuring insurance coverage and medical necessity. For jobs related to healthcare or insurance, understanding pre-certification processes involves knowledge of documentation, approval timelines, and compliance with regulations.

What are the key skills and qualifications needed to thrive as a Pre-Certification Specialist, and why are they important?

To thrive as a Pre-Certification Specialist, you need a solid understanding of medical terminology, insurance policies, and healthcare procedures, often supported by a background in healthcare administration or medical billing. Familiarity with pre-authorization systems, electronic health records (EHRs), and payer portals is typically required. Excellent attention to detail, organizational skills, and effective communication are crucial soft skills for this role. These competencies are essential to ensure accurate, timely insurance approvals and to facilitate uninterrupted patient care and reimbursement.

What are some common challenges faced in a Pre Certification role and how can they be managed effectively?

Professionals in Pre Certification often encounter challenges such as navigating complex insurance requirements, managing high volumes of authorization requests, and staying up-to-date with frequent policy changes. Effective communication with healthcare providers and insurance companies is essential to ensure timely approvals and minimize delays in patient care. Developing strong organizational skills, leveraging electronic health record (EHR) systems, and participating in regular training can help manage these challenges and improve workflow efficiency.
What cities are hiring for Pre Certification jobs? Cities with the most Pre Certification job openings:
What are the most commonly searched types of Pre Certification jobs? The most popular types of Pre Certification jobs are:
What states have the most Pre Certification jobs? States with the most job openings for Pre Certification jobs include:
What job categories do people searching Pre Certification jobs look for? The top searched job categories for Pre Certification jobs are:
Pre Certification jobs near you
Infographic showing various Pre Certification job openings in the United States as of June 2026, with employment types broken down into 80% Full Time, and 20% Part Time. Highlights an 95% In-person, and 5% Hybrid job distribution, with an average salary of $73,307 per year, or $35.2 per hour.

Pre-Certification Specialist

Rehabilitation and Neurological Service, LLC

Huntsville, AL

$15 - $20/hr

Full-time

Medical, Dental, Vision, Retirement

Posted 20 days ago

Job description

Pre-Certification Specialist Job Description
Rehabilitation and Neurological Services LLC

Position Overview

The Pre-Certification Specialist is responsible for obtaining prior authorizations and pre-certification approvals from insurance carriers to ensure timely access to medically necessary services, procedures, medications, diagnostic testing, and specialty treatments. This position plays a critical role in minimizing delays in patient care, reducing claim denials, and ensuring compliance with payer requirements.
The ideal candidate will possess strong organizational skills, attention to detail, and the ability to work efficiently in a fast-paced medical office environment. Experience with neurology-related procedures, spinal injections, joint injections, and knowledge of CPT coding is strongly preferred.

Key Responsibilities

Pre-Certification & Authorization Management

  •  Obtain prior authorizations and pre-certifications for medical procedures, diagnostic testing, imaging, medications, specialty services, and office-based procedures. 
  •  Verify insurance eligibility, benefits, coverage limitations, and authorization requirements. 
  •  Submit complete and accurate clinical information to insurance carriers to support medical necessity. 
Procedure Knowledge & Coordination

  •  Demonstrate preferred knowledge of spinal injections, joint injections, pain management procedures, neurology-related services, and associated payer requirements. 
  •  Understand procedure-specific authorization guidelines and medical necessity criteria. 
  •  Coordinate with providers and clinical staff regarding procedure scheduling pending authorization approval. 
CPT Coding & Documentation

  •  Maintain working knowledge of CPT, ICD-10, and HCPCS coding, with preferred experience interpreting CPT codes related to spinal and joint injection procedures. 
  •  Review physician orders, clinical documentation, and coding information to ensure authorization accuracy and completeness. 
  •  Ensure all supporting medical records and documentation meet insurance and regulatory standards. 
Communication & Coordination

  •  Serve as a liaison between healthcare providers, insurance companies, patients, and clinical staff to facilitate efficient authorization processing. 
  •  Communicate authorization statuses, denials, and additional documentation requirements to appropriate team members. 
  •  Educate patients, when appropriate, regarding insurance authorization requirements and scheduling delays. 
Follow-Up & Denial Management

  •  Track and follow up on pending authorization requests to ensure timely approvals and avoid disruptions in patient care. 
  •  Investigate, appeal, and assist in resolving denied or delayed authorization requests. 
  •  Maintain detailed records of authorization statuses, reference numbers, and payer communications. 
Data Entry & Record Maintenance

  •  Accurately enter and maintain authorization and pre-certification information within the Electronic Health Record (EHR) and other applicable systems. 
  •  Maintain organized records of approvals, denials, expiration dates, and payer requirements. 
Compliance & Regulatory Awareness

  •  Stay current on insurance policies, payer updates, prior authorization requirements, and regulatory guidelines. 
  •  Ensure compliance with HIPAA, payer regulations, and organizational policies and procedures. 
Qualifications

Education

  •  High School Diploma or equivalent required. 
  •  Associate’s or Bachelor’s degree in Healthcare Administration, Medical Billing & Coding, Business Administration, or a related healthcare field preferred. 
Experience

  •  Minimum of 2–3 years of experience in a healthcare, medical office, or insurance setting with a focus on prior authorizations, pre-certification, or insurance verification preferred. 
  • Neurology, pain management, orthopedic, or specialty medical office experience preferred.
Skills & Knowledge

  •  Strong knowledge of insurance pre-certification, prior authorization, and payer requirements. 
  • Preferred knowledge of spinal injections, joint injections, and specialty procedure authorization workflows. 
  • Working knowledge of CPT, ICD-10, and HCPCS codes, with preference given to candidates familiar with injection-related CPT coding.
  •  Strong attention to detail and organizational skills. 
  •  Excellent communication and interpersonal skills. 
  •  Proficiency in Electronic Health Records (EHR) and medical office software. 
  •  Ability to multitask, prioritize, and work independently in a fast-paced environment. 
Preferred Certifications

  • Certified Professional Coder (CPC) preferred but not required. 
  •  Medical billing and coding certification is a plus. 
What We Offer

  •  Competitive salary and benefits package 
  •  Health, dental, and vision insurance 
  •  Retirement savings plan with company match 
  •  Opportunities for professional development and growth 
  •  Supportive, team-oriented work environment