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Precertification Specialist Jobs (NOW HIRING)

Addison Group

Precertification Specialist

Smyrna, GA · On-site

$22/hr

Precertification Specialist Location: Smyrna, GA Compensation: $22.00 per hour Employment Type: Contract-to-Hire fully onsite Schedule: Monday-Friday, 8:00 AM-5:00 PM Benefits: This position is ...

Addison Group

Precertification Specialist

Smyrna, GA · On-site

$22/hr

Precertification Specialist Location: Smyrna, GA Compensation: $22.00 per hour Employment Type: Contract-to-Hire fully onsite Schedule: Monday-Friday, 8:00 AM-5:00 PM Benefits: This position is ...

Bridgeview Eye Partners

Precertification Specialist

Wabash, IN · On-site

$15.75 - $19.50/hr

Cataract & Laser Institute is seeking a detail-oriented and dependable Precertification Specialist to join our team. In this role, you will help ensure patients receive timely access to surgical care ...

Bridgeview Eye Partners

Precertification Specialist

Wabash, IN · On-site

$15.75 - $19.50/hr

Cataract & Laser Institute is seeking a detail-oriented and dependable Precertification Specialist to join our team. In this role, you will help ensure patients receive timely access to surgical care ...

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Precertification Specialist information

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How much do precertification specialist jobs pay per hour?

As of Sep 1, 2026, the average hourly pay for precertification specialist in the United States is $16.99, according to ZipRecruiter salary data. Most workers in this role earn between $15.14 and $18.51 per hour, depending on experience, location, and employer.

What is a precertification specialist?

Precertification Specialists are healthcare professionals responsible for obtaining authorization from insurance companies before certain medical procedures, treatments, or hospital admissions. They review patient information, communicate with medical providers, and ensure that all necessary documentation is provided to insurers. Their main goal is to confirm coverage and prevent claim denials, helping patients and healthcare providers navigate insurance requirements efficiently. Precertification Specialists play a crucial role in the administrative side of healthcare, ensuring compliance and supporting patient care.

What does a precertification specialist do?

A Precertification Specialist acts as a liaison between healthcare providers, patients, and insurance companies to ensure that required medical procedures, tests, or medications are authorized before services are rendered. This role involves frequent communication with physicians' offices to gather clinical information and with insurance representatives to clarify coverage or obtain approvals. Effective collaboration and attention to detail are essential, as specialists must track multiple cases simultaneously and ensure all documentation meets payer requirements. Strong interpersonal skills help streamline the process and minimize delays in patient care.

What skills and qualifications are needed to be a precertification specialist?

To excel as a Precertification Specialist, you need a solid understanding of medical terminology, insurance policies, and healthcare procedures, often supported by a high school diploma or associate degree and relevant experience. Familiarity with healthcare management software, electronic medical records (EMR), and payer portals is typically required. Strong attention to detail, organizational skills, and effective communication are crucial soft skills for accurately processing requests and interacting with patients and providers. These competencies ensure timely and accurate insurance authorizations, minimizing delays in patient care and reducing claim denials.

What is the difference between Precertification Specialist vs Medical Billing Specialist?

AspectPrecertification SpecialistMedical Billing Specialist
CredentialsTypically requires certification in healthcare or insurance, such as AHIP or AAPCOften requires certification in medical billing or coding, like CPC or CPC-A
Work EnvironmentHospitals, insurance companies, healthcare providersMedical offices, billing companies, healthcare providers
Job FocusSecuring prior approvals for procedures and treatmentsProcessing and submitting insurance claims for payment

The Precertification Specialist primarily focuses on obtaining prior approvals for medical procedures, ensuring insurance coverage before treatment. In contrast, the Medical Billing Specialist handles the billing process after services are rendered, managing claims and payments. While both roles require knowledge of insurance policies and healthcare regulations, their core responsibilities differ significantly.

How do I become a precertification specialist?

To become a precertification specialist, candidates typically need a high school diploma or equivalent, along with knowledge of insurance policies and medical billing. Relevant skills include attention to detail, communication, and familiarity with healthcare management software. Some employers may prefer or require certification in medical billing or coding.

How much does a precertification specialist make?

A precertification specialist typically earns between $40,000 and $60,000 annually, depending on experience, location, and employer. Salaries can vary based on certifications, such as Certified Medical Reimbursement Specialist (CMRS), and the complexity of the healthcare setting they work in.
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Precertification Specialist jobs near you
Infographic showing various Precertification Specialist job openings in the United States as of August 2026, with employment types broken down into 87% Full Time, 11% Part Time, and 2% Contract. Highlights an 78% Physical, 2% Hybrid, and 20% Remote job distribution, with an average salary of $35,336 per year, or $17 per hour.

Precertification Specialist

Philadelphia, PA • On-site

The Emerson Group
See more jobs at The Emerson Groupexternal

$26/hr

Other

This job post has expired today. Applications are no longer accepted.

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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