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Precertification Jobs in Philadelphia, PA (NOW HIRING)

Temple Health

Precertification Rep

Philadelphia, PA · On-site

$40K - $55K/yr

This position is responsible for confirming and satisfying all authorization billing requirements by obtaining the appropriate precertification/authorization from all necessary payers to avoid delays ...

Temple Health

Lead Patient Access Rep

Philadelphia, PA

$17.50 - $22.25/hr

Serves as the lead resource to the Preregistration or Precertification staff within the Patient Access departments. Supports the Manager of the area to ensure the staff is receiving the proper ...

Hunterdon Health

Claim Recovery Specialist

Flemington, NJ · On-site

$20.50 - $25.63/hr

Secures precertification, preauthorization, and referrals. * Researches, communicates and collects copay/coinsurance obligations. * Completes Insurance Notifications. Qualifications Minimum Education

Hunterdon Health

Claim Recovery Specialist

Flemington, NJ · On-site

$20.50 - $25.63/hr

Secures precertification, preauthorization, and referrals. * Researches, communicates and collects copay/coinsurance obligations. * Completes Insurance Notifications. Qualifications Minimum Education

Temple Health

Lead Patient Access Rep

Philadelphia, PA · On-site

$17.50 - $22.25/hr

Lead Preregistration Representative Serves as the lead resource to the Preregistration or Precertification staff within the Patient Access departments. Supports the Manager of the area to ensure the ...

Jefferson

Authorization Representative

Abington, PA · On-site

$16.50 - $21/hr

Interfaces with insurance companies, both directly and indirectly, to verify coverage, benefits and obtain precertification. * Reviews and verifies additional clinical information, insurance ...

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All JobsPrecertification JobsPrecertification Jobs in Philadelphia, PA

Precertification information

See Philadelphia, PA salary details

$5

$19

$30

How much do precertification jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for precertification in Philadelphia, PA is $19.10, according to ZipRecruiter salary data. Most workers in this role earn between $15.05 and $27.64 per hour, depending on experience, location, and employer.

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 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 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 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 popular job titles related to Precertification jobs in Philadelphia, PA? For Precertification jobs in Philadelphia, PA, the most frequently searched job titles are:
What job categories do people searching Precertification jobs in Philadelphia, PA look for? The top searched job categories for Precertification jobs in Philadelphia, PA are:
Precertification jobs near you
Infographic showing various Precertification job openings in Philadelphia, PA as of August 2026, with employment types broken down into 67% Full Time, and 33% Part Time. Highlights an 100% In-person job distribution, with an average salary of $39,726 per year, or $19.1 per hour.

Precertification Specialist

The Emerson Group

Philadelphia, PA • On-site

$26/hr

Other

Re-posted 25 days ago

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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