Pre-Certification Specialist

The Pre-Certification Specialist is responsible for utilizing the electronic medical record system to abstract information and prove medical necessity to payors, ensuring precertification for services is obtained prior to the date of service. This role involves researching authorization issues, recommending process improvements to reduce denials, and collaborating with providers and staff to ensure accurate authorizations. The position also includes reviewing cases for anticipated denials, scheduling peer reviews, and completing post-procedure reviews to update existing authorizations.