Pre-Certification Specialist

Under general supervision, the Pre-Certification Specialist confirms patient eligibility and benefits for all Medicare, Medicaid, Government, and all Commercial Carriers. Identifies and corrects internal problems within assigned accounts to expedite payments from insurance companies. Obtains precertification for required procedures as it relates to Physical and Occupational Therapy services. All required information is documented in Practice Management System in a timely and accurate manner prior the patient appointment. The position involves a large volume, calling patients and insurance companies. Serves as liaison between patient, insurance company, physician, therapist, and facility. Substitutes in other areas of the business office as needed.

Essential Functions

• Responsible for working from assigned Work Queues of scheduled New and Established Therapy procedures
• Verify insurance and benefits for scheduled Therapy procedures
• Obtain insurance authorization when needed
• Responsible for ensuring information in practice management system is correct
• Responsible for communicating with insurance companies, office staff/Provider, and patients as needed
• Responsible for following PT Solutions guidelines.
• Ability to work independently, prioritize tasks and to work under pressure and deadlines
• Ability to multi-task, responsible for following up on pending cases while initiating new cases
• Responsible for scanning documents into patients’ chart within EMR
• Knowledge of medical terminology, with an emphasis on Physical and Occupational Therapy
• Ability to perform basic math calculations
• Follows all OSHA standards and guidelines
• Maintains patient confidentiality
• Performs other duties, responsibilities, and functions as may be required from time to time

Required Skills & Abilities

• Proficiency in Microsoft Word, Excel, Window-based applications.
• Excellent communication and relationship-building skills.
• Must have demonstrated skill in prioritizing daily responsibilities and crises to handle a heavy workload.
• Must be able to work successfully in a fast-paced environment.
• Knowledge of federal and state employment laws and regulations

Required Credentials

• High school diploma or equivalent; associate degree or healthcare certification preferred.
• 2+ years of experience in healthcare insurance verification, utilization review, or prior authorization (preferably in a physical therapy or outpatient setting).
• Understanding of medical insurance terminology and prior authorization processes.
• Experience working with commercial payers, Medicare, and Medicaid plans.
• Excellent attention to detail, organizational skills, and time management.
• Strong communication skills with the ability to collaborate across clinical and administrative teams.

Expanding Access to Quality Care

At PT Solutions, we’re more than colleagues; we’re a tight-knit community united in our mission to expand access to quality care. Our commitment to you is evident in our industry-leading professional development opportunities. From ongoing evidence-based clinical education to dedicated mentorship opportunities and an APTA-accredited Orthopaedic Residency Program, we propel our clinicians toward excellence in physical therapy, occupational therapy, speech-language pathology, and athletic training.

As we aim to be the go-to rehabilitation provider, we seek committed professionals eager to join us in that mission. A career with PT Solutions is an opportunity to shape the industry and make a lasting impact. 

Let’s go further together and transform care. Join the #PTSLife today! 

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