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Precertification Jobs in Massachusetts (NOW HIRING)

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Precertification information

What is a precertification specialist?

Precertification jobs involve reviewing and approving medical procedures, treatments, or hospital admissions before they occur to ensure they meet insurance or regulatory requirements. Professionals in these roles typically evaluate patient information, communicate with healthcare providers, and coordinate with insurance companies to determine if services will be covered. This process helps control healthcare costs and ensures that patients receive appropriate care according to established guidelines. Precertification specialists often work in hospitals, insurance companies, or healthcare administration settings.

What skills and qualifications are needed to thrive as a precertification specialist?

Success as a precertification specialist requires knowledge of medical terminology, insurance verification, and healthcare regulations, often supported by a background in healthcare administration or certification such as Certified Medical Administrative Assistant (CMAA). Familiarity with insurance portals, electronic health record (EHR) systems, and payer-specific software is typically necessary. Attention to detail, strong organizational skills, and effective communication are vital soft skills that help in coordinating between providers, patients, and insurers. These abilities ensure accurate and timely approval of medical procedures, reducing delays in patient care and minimizing claim denials.

What are common challenges faced by precertification specialists, and how can they be addressed?

Precertification Specialists often face challenges such as staying up-to-date with constantly changing insurance guidelines, managing high volumes of requests, and communicating effectively with both healthcare providers and insurance representatives. To address these, it is important to maintain strong organizational skills, leverage available technology for tracking authorizations, and participate in ongoing training to remain current on payer requirements. Building good relationships with team members and regularly sharing updates can also help streamline processes and minimize delays.

What is the difference between Precertification vs Medical Coder?

AspectPrecertificationMedical Coder
Required credentialsCertification may be preferred; knowledge of insurance policiesCertification (e.g., CPC, CCS) often required
Work environmentHealthcare facilities, insurance companies, outpatient clinicsHospitals, clinics, insurance companies, remote work
Employer usageUsed to approve procedures before serviceUsed to assign codes for billing and documentation
Common search intentPrecertification vs Medical Coder

Precertification involves obtaining approval from insurance companies before procedures, focusing on insurance policies and patient eligibility. Medical coders assign standardized codes to medical records for billing, emphasizing coding accuracy and documentation. While both roles are integral to healthcare billing, precertification is about approval processes, whereas medical coding centers on documentation and coding accuracy.

What are the most commonly searched types of Precertification jobs in Massachusetts?

The most popular types of Precertification jobs in Massachusetts are:

What are popular job titles related to Precertification jobs in Massachusetts?

For Precertification jobs in Massachusetts, the most frequently searched job titles are:

What job categories do people searching Precertification jobs in Massachusetts look for?

The top searched job categories for Precertification jobs in Massachusetts are:

Precertification jobs near you
Infographic showing various Precertification job openings in Massachusetts as of August 2026, with employment types broken down into 5% As Needed, 82% Full Time, 12% Part Time, and 1% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution.

Per Diem-Scheduling Coordinator

South Shore Health

Weymouth, MA • On-site

$22.20 - $31.75/hr

Other

Posted 6 days ago

South Shore Health rating

7.8

Company rating: 7.8 out of 10

Based on 53 frontline employees who took The Breakroom Quiz

128th of 887 rated healthcare providers

Job description

If you are an existing employee of South Shore Health then please apply through the internal career site.
Requisition Number:
R-23484
Facility:
LOC0001 - 55 Fogg Road55 Fogg RoadWeymouth, MA 02190
Department Name:
SSH Perinatology
Status:
Part time
Budgeted Hours:
0
Shift:
Day (United States of America)
Under the direction of the Manager of Patient Access Services, is responsible for patient scheduling, pre-registration , insurance authorization and precertification for the scheduled services.
Compensation Pay Range:
$22.20 - $31.75
ESSENTIAL FUNCTIONS
Scheduling Coordinator - Maternal Fetal Medicine
Basic Purpose of the Job: The Scheduling Coordinator is a vital member of the Maternal Fetal Medicine (MFM) team, responsible for coordinating all aspects of patient scheduling, medical records management, and insurance authorizations. This role ensures that patients, referring providers, and internal team members receive timely, efficient, and compassionate care. The Scheduling Coordinator acts as a liaison to optimize patient access, streamline clinic operations, and support a seamless healthcare experience.
Key Responsibilities:
Patient Scheduling & Coordination:
  • Schedule and confirm all MFM, Birthing Center, NICU, Pediatric, Diabetes in Pregnancy and Nutrition in Pregnancy appointments, including ultrasounds, genetic counseling, surgeries, inductions, and consultations.
  • Transcribe incoming orders and referrals for outside practices for appointments/procedures and create cases for surgical patients.
  • Manage scheduling adjustments based on patient conditions and provider availability.
  • Monitor daily EPIC workqueues, including ultrasound orders, self-pay, non-contracted insurance and referral authorization.
  • Coordinate with internal departments and external obstetrical practices, fertility clinics, laboratories and hospitals.
  • Monitor and modify provider schedule templates to ensure efficient use of clinical resources.
  • Facilitate approval processes for inductions, cervical ripening and C-sections outside established guidelines.
  • Support the workflow of the MFM and Birthing Center Departments, assisting with check-in, patient flow, and distribution of schedules to relevant stakeholders.
  • Complete a full registration for new patients and confirm updates for established patients.
  • Reviews any non-standard or scheduling issues with Practice Manager, Sonographer Manager or other impacted departments.
  • Works with other MFM personnel to provide efficient and correctly prioritized management of patient appointments and hospital resources. Consult with physicians to determine urgency.
  • Schedule interpreter services to make certain patient needs are met.

Insurance & Financial Coordination:
  • Utilize electronic systems (EPIC, Passport OneSource) to verify insurance eligibility/coverage and ensure accurate information; may require contacting insurance carrier.
  • Actively monitor and correct insurance discrepancies prior to the date of service
  • Knowledge of payer policies for medical necessity/authorization requirements.
  • Able to identify and transcribe ICD-10 diagnosis and procedure CPT codes from referring provider into EPIC.
  • Request prior authorizations when required, including informing patients, submitting correct CPT and ICD-10 codes, documenting authorization details in medical record, and communicating potential financial responsibility to patients.
  • Prepare patient estimates (self-pay, non-participating insurance coverage) for outpatient services, using the correct CPT codes.
  • Works with SSH billing personnel/systems and private offices to resolve patient billing.
Medical Records & Administrative Support:
  • Manage incoming and outgoing communication, including faxing, email correspondence, and distribution of schedules.
  • Maintain comprehensive and up-to-date patient charts, ensuring compliance with privacy regulations.
  • Obtains all patient information required by the providers prior to an appointment.
  • Ensures that the medical records are available to all health care providers by scanning into EPIC.
  • Manages all incoming and outgoing information transfer for patients referred for services outside SSH.
Customer Service:
  • Serve as a primary point of contact for patients, addressing inquiries with professionalism and empathy.
  • Serves as patient primary point of contact and liaison to communicate patient needs and feedback to appropriate clinical team members.
  • Provide clear information and information on appointment preparation, practice guidelines, and hospital services.
  • Collaborate with Practice Manager, clinicians, and support staff to ensure smooth clinic flow and optimal utilization of resources.
  • Proactively identify and recommend strategies to improve access and reduce patient care barriers.
  • Assist with new employee onboarding and orientation.
  • Able to multi-task and answer a multi-phone line and tolerate continuous interruptions to complete task at hand
  • Greets and acknowledges all colleagues, patients, vendors, visitors and vendors with professionalism, both in office and on telephone
  • Ensures that patients, referring providers and other customers receive timely, efficient and high-quality service.
Compliance & Safety:
  • Adhere to all legal, regulatory, and ethical standards relevant to patient care and hospital operations.
  • Maintain a safe work environment, following proper body mechanics and equipment usage protocols.
  • Participate in mandatory safety, compliance, and privacy training programs.
  • Ensure accuracy in patient demographic and insurance information, safeguarding privacy and supporting hospital financial operations.
  • Operate independently within established guidelines, demonstrating initiative and problem-solving skills.
  • All other duties as assigned.

JOB REQUIREMENTS
Minimum Education - Preferred
Associates degree preferred.
Life experiences considered
Minimum Work Experience
2-5 years experience in Patient Registration, Billing dept., Scheduling dept., or MD offices.
Required additional Knowledge, and Abilities
Knowledge of medical terminology.
Telephone experience required.
Strong Computer Skills
Customer Service experience required.
Insurance Third party requirements.
Ability to work under pressure.
Works independently/make decisions on their own.
Can function as part of a team.
Varied Hours
Monday- Friday
Responsibilities if Required:
Education if Required:
License/Registration/Certification Requirements:

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About South Shore Health

Sourced by ZipRecruiter

South Shore Health is a leading provider of health services in South Weymouth, Massachusetts, US. As an integrated health system, the company has a broad offering ranging from primary and specialty care, home health and hospice services, to preventive and emergency care. Founded over a century ago, South Shore Health initially operated as a single hospital but has since morphed into a health network of providers and facilities for comprehensive care. The company's mission is to benefit the community by providing easily accessible, top-quality health services with an emphasis on wellness and prevention.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

South Weymouth, MA, US

Year founded

1922

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