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Precertification Analyst Jobs in Texas (NOW HIRING)

CYNET SYSTEMS

Precertification Coordinator

Houston, TX · On-site

$24/hr

Minimum 2+ years of experience in working in precertification. * Working knowledge of managed care ... Familiarity with ICD-9 and ICD-10. * Strong analytical skills with the ability to assess and ...

First Connect Health

RN - Utilization review

Austin, TX · On-site

... precertification, reimbursement and claim denials/appeals. • Assesses and coordinates discharge planning needs with healthcare team members. • May prepare statistical analysis and utilization ...

New

Ascension Seton - Austin

RN - Case Manager

Austin, TX · On-site

... precertification, reimbursement, and claim denials/appeals. Assesses and coordinates discharge planning needs with healthcare team members. May prepare statistical analysis and utilization review ...

New

United Musculoskeletal Partners

Surgery Scheduler

Addison, TX · On-site

$18.25 - $23.50/hr

Enters benefits and precertification/authorization into EMR system (Referral Management ... Background in medical terminology, Orthopedics/Spine, and ability to analyze medical situations for ...

Texas Spine Consultants

Surgery Scheduler

Addison, TX · On-site

$18.25 - $23.50/hr

Enters benefits and precertification/authorization into EMR system (Referral Management ... Background in medical terminology, Orthopedics/Spine, and ability to analyze medical situations for ...

United Musculoskeletal Partners

Surgery Scheduler

Addison, TX · On-site

$18.25 - $23.50/hr

Enters benefits and precertification/authorization into EMR system (Referral Management ... Background in medical terminology, Orthopedics/Spine, and ability to analyze medical situations for ...

Resurgens Orthopaedics

Surgery Scheduler

Addison, TX · On-site

$18.25 - $23.50/hr

Enters benefits and precertification/authorization into EMR system (Referral Management ... Background in medical terminology, Orthopedics/Spine, and ability to analyze medical situations for ...

Resurgens Orthopaedics

Surgery Scheduler

Addison, TX · On-site

$18.25 - $23.50/hr

Enters benefits and precertification/authorization into EMR system (Referral Management ... Background in medical terminology, Orthopedics/Spine, and ability to analyze medical situations for ...

RK&K

CEI Project Manager

Austin, TX · On-site

Certification in TxDOT Precertification Categories (11.1.1, 11.2.1, 11.3.1, and 11.4.1) or ability ... Ability to analyze information and develop actionable plans. * Acceptable driving record and ...

Rummel Klepper and Kahl

CEI Project Manager

Austin, TX · On-site

Certification in TxDOT Precertification Categories (11.1.1, 11.2.1, 11.3.1, and 11.4.1) or ability ... Ability to analyze information and develop actionable plans. * Acceptable driving record and ...

Stantec

Traffic Engineer

Plano, TX · On-site

$81K - $110K/yr

Projects include traffic signal system design and re-timing, operational analysis, roadway capacity ... TxDOT Precertification preferred This description is not a comprehensive listing of activities ...

Stantec

Traffic Engineer

Plano, TX · On-site

$77K - $106K/yr

Projects include traffic signal system design and re-timing, operational analysis, roadway capacity ... TxDOT Precertification preferred This description is not a comprehensive listing of activities ...

Stantec

Traffic Engineer

Austin, TX · On-site

$86K - $117K/yr

Projects include traffic signal system design and re-timing, operational analysis, roadway capacity ... TxDOT Precertification preferred This description is not a comprehensive listing of activities ...

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Precertification Analyst information

What is a precertification analyst?

A Precertification Analyst is a healthcare professional responsible for reviewing medical procedures, tests, or hospital admissions to determine if they meet insurance policy requirements before they are performed. They work with healthcare providers, insurance companies, and patients to ensure that necessary authorizations are obtained and that the services are covered. Their role helps prevent insurance claim denials and ensures compliance with healthcare regulations. Precertification Analysts must have strong attention to detail, knowledge of medical terminology, and the ability to interpret insurance guidelines.

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

To thrive as a Precertification Analyst, you need a solid understanding of healthcare insurance processes, medical terminology, and prior authorization requirements, often supported by experience in medical billing or certification in healthcare administration. Familiarity with insurance verification systems, electronic health records (EHR), and claims management software is typically required. Attention to detail, strong organizational skills, and effective communication help analysts efficiently handle complex cases and collaborate with providers and payers. These skills are crucial to ensure timely and accurate precertification approvals, reducing claim denials and supporting patient access to necessary care.

What are some common challenges faced by precertification analysts, and how can they be managed effectively?

Precertification Analysts often encounter challenges such as managing a high volume of requests, navigating complex insurance policies, and ensuring timely communication between healthcare providers and insurance companies. Staying organized and utilizing electronic health record (EHR) systems can help streamline workflows. Building strong relationships with clinical staff and insurance representatives also aids in resolving issues quickly. Continuous learning about evolving insurance guidelines is essential to stay effective in this role.

What is the difference between Precertification Analyst vs Claims Processor?

AspectPrecertification AnalystClaims Processor
Required credentialsHigh school diploma or equivalent; certifications like CPC or CCS may be preferredHigh school diploma or equivalent; certifications are less common
Work environmentHealthcare offices, insurance companies, or hospitalsInsurance companies, healthcare providers, or billing departments
Employer and industry usageUsed in health insurance and healthcare settings to review prior authorizationUsed in insurance and healthcare to process and review claims for payment

While both roles are involved in healthcare billing and insurance processes, a Precertification Analyst primarily reviews and authorizes procedures before treatment, whereas a Claims Processor handles the billing and reimbursement after services are provided. Understanding these differences helps clarify career paths and employer expectations in the healthcare insurance industry.

What cities in Texas are hiring for Precertification Analyst jobs?

Cities in Texas with the most Precertification Analyst job openings:

Precertification Coordinator

Houston, TX • On-site

CYNET SYSTEMS
IT Services • 501 - 1,000 employees
Learn more about CYNET SYSTEMSexternal

$24/hr

Contractor

Re-posted 29 days ago

Job description

Job Overview:

Requirement/Must Have:

  • Minimum 2+ years of experience in working in precertification.
  • Working knowledge of managed care in all areas, most notably: referrals, insurance verification, and precertification.
  • Knowledge of medical terminology.
  • Familiarity with ICD-9 and ICD-10.
  • Strong analytical skills with the ability to assess and analyze trends to determine the most effective approach to bill.
  • Detail-oriented and strong critical thinking skills for solving problems on your own.
  • Ability to perform multiple tasks simultaneously and problem solve efficiently.
  • Excellent organizational and interpersonal skills.
  • Strong desire to learn and utilize technology effectively.
  • Some experience with Microsoft Office including Teams.
  • Quickly able to enter data accurately and understand the information entered.
  • Flexibility to work overtime occasionally, typically when onboarding new clients.

Responsibilities:

  • Accurately complete all fields in the patient demographic and insurance screens within the computer system.
  • Call the patient's insurance company to verify eligibility and obtain benefit coverage for office visits, outpatient tests, surgery, and inpatient admissions.
  • Attempt to obtain and document in the computer system referral details and referral modifications for specialty care and testing for patients with insurance plans requiring formal referral documentation.
  • Obtain and document in the computer system the precertification/preauthorization number from insurance companies prior to each surgical procedure and diagnostic test.
  • Assist patients with scheduling new patient office visits with CVCP provider offices.
  • Create and distribute the CVCP Inpatient and Outpatient Service Lists and manifests to CVCP surgeons and consultants.
  • Complete all fields within the computer system necessary to process claims and re-route claims to the billing department per assigned deadline.
  • Distribute The Admit List daily by 1 p.m., identify possible CVCP patients, and distribute the list to precertification staff for processing.
  • Correct any account in which errors have occurred per the assigned deadline.
  • Maintain constant communication among the physician, insurance company, and CVCP regarding authorization and the CVCP authorization status on patients.
  • Maintain a minimum average of 30 CVCP authorizations per day with proven accuracy after 3 months.
 

Founded in 2010 and headquartered in the Washington, DC metro area, Cynet Systems Inc. is a leading staffing and recruiting powerhouse. Proudly recognized as a nationally and locally certified diversity firm, Cynet delivers agile, scalable talent solutions across industries. With an active footprint in all 50 U.S. states and Canada, we support thousands of consultants through our expansive, high-performing recruitment engine operating across North America and Asia—ensuring speed, quality, and consistency in every hire.
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About Cynet Systems

Sourced by ZipRecruiter

Cynet Systems Inc is a staffing and recruiting corporation nestled in Ashburn, VA, USA. Established in 2010, the company operates within the Information Technology and Services sector, specializing in providing effective workforce solutions to different business needs, including IT consulting, direct hire, and contract staffing services. Through the years, Cynet Systems has built an impressive portfolio, going beyond borders and expanding its operations internationally in Canada and India. Rooted in its core values of teamwork, leadership, and commitment, Cynet Systems helps businesses unlock their full potential by providing versatile and competent professionals that perfectly align with their needs. Fueled by their unwavering mission to deliver top-tier talent to businesses worldwide, Cynet Systems garnered various recognitions including SIA's fastest-growing staffing firms and Best Place to Work in Virginia for 2019.

Industry

It services

Company size

501 - 1,000 Employees

Headquarters location

Sterling, VA, US

Year founded

2010

Social media

Twitter

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