Two Chicks With A Side Hustle

Position Summary:

  • The Pre-Certification Specialist is responsible for supporting the Precertification Nurse, Medical Director and Director of Health Services by collecting, interpreting and evaluating medical information received for authorization.
  • The Pre-cert Specialist will communicate with internal and external providers regarding authorization status.

Essential Duties and Responsibilities:

  • Receive request for authorization from hospitals, providers, customers and vendors via fax, phone and portal
  • Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate)
  • Determine authorization requirements based on company policy, member benefit grid and provider status
  • Review customer coverage and benefits
  • Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Utilization Management Nurse)
  • Maintain benchmark standards for TAT (Turn-Around-Time) as established by the organization.
  • Professional demeanor and the ability to work effectively within a team or independently
  • Flexible with the ability to shift priorities when required
  • Maintains regular and acceptable attendance in accordance with Time Away From Work policy
  • Ability to work evening, weekend and holiday shifts to support the UM Department
  • Other duties as requested


  • High School Diploma and preferred 1-2 years’ experience in a managed care environment
  • Proficient in medical terminology, CPT, HCPCS and ICD-10 coding
  • Effective oral and written communication skills
  • Strong customer orientation
  • Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word
  • Excellent typing skills

Knowledge, Skills, Abilities Required:

  • Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a customer
  • Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environment
  • Proficient knowledge of departmental policies and procedures
  • Knowledge of Medicare Regulatory Requirements