Revenue Cycle Precert Specialist

Make an Impact Every Day

As a Revenue Cycle PreCert Specialist, you'll play a vital role in helping patients receive the care they need by ensuring insurance authorizations are secured before services are provided. Your work helps create a seamless experience for patients and providers while supporting timely reimbursement and reducing delays in care.

If you enjoy problem-solving, working with insurance and healthcare systems, collaborating with clinical teams, and making a meaningful difference behind the scenes, this is an opportunity to build a rewarding career within Revenue Cycle.

What You'll Do

In this role, you will:

• Obtain and verify prior authorizations for outpatient testing, ambulatory procedures, and inpatient services before care is delivered.
• Review insurance eligibility, coverage, benefits, and payer requirements to help ensure services are authorized and reimbursable.
• Use electronic eligibility tools, payer websites, and direct communication with insurance companies to verify coverage and resolve authorization needs, including out-of-network and non-covered services.
• Submit authorization requests, notifications, clinical documentation, and supporting information in accordance with payer guidelines and contractual requirements.
• Partner with providers, clinical teams, and operational departments to gather necessary documentation and keep the authorization process moving efficiently.
• Communicate authorization updates, potential delays, denials, and peer-to-peer review requests while following established policies and escalation procedures.
• Provide excellent customer service through professional communication with patients, providers, payers, and internal team members via phone, email, and other correspondence.
• Stay current on insurance regulations, managed care requirements, government payer guidelines, and Revenue Cycle policies to support accurate and compliant work.
• Scan, retrieve, and maintain required documentation within electronic systems.
• Participate in team meetings, training, and ongoing learning opportunities while maintaining the highest standards of patient and physician confidentiality.
• Meet established quality, productivity, and service standards that support the success of the Revenue Cycle team.

What You'll Bring

Success in this role comes from strong attention to detail, excellent communication skills, and the ability to manage multiple priorities in a fast-paced environment. You'll thrive if you enjoy collaborating with others, navigating complex insurance requirements, and finding solutions that support both patients and care teams.

Additional Information

• Perform other duties as assigned.
• Follow all organizational policies, procedures, and standards.
• Receive department-specific training and orientation to support your success in the role.
• Safeguard Protected Health Information (PHI) by adhering to HIPAA requirements, the UH Code of Conduct, annual training, and all applicable privacy and security policies.

Education

• High School Equivalent / GED (Required)
• Other Accredited Program: Medical Terminology (Preferred)

Work Experience

• 3+ years' experience in hospital Revenue Cycle/healthcare, working with insurance companies/third-party payers or related experience (Required)
• Experience with clinical applications (Preferred)

Knowledge, Skills, & Abilities

• Knowledge of managed care insurance requirements is essential. (Required proficiency)
• Notable client service, communication and relationship building skills. (Required proficiency)
• Ability to function independently and as a team player in a fast-paced environment. (Required proficiency)
• Must have strong written and verbal communication skills. (Required proficiency)
• Professional demeanor (Required proficiency)
• Detail-oriented and organized, with good analytical and problem solving ability (Required proficiency)
• Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, multi-line phone, FAX machine, etc.). (Required proficiency)

Physical Demands

• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely up to 20 lbs
• Carrying Rarely up to 20 lbs
• Pushing Rarely up to 20 lbs
• Pulling Rarely up to 20 lbs
• Climbing Rarely up to 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently

Travel Requirements

10%