Revenue Cycle Precert Specialist

Help patients access the care they need—before they even walk through the door.

As a valued member of our Revenue Cycle team, you’ll play an important role in creating a smoother, less stressful healthcare experience for patients and providers alike. In this role, you’ll help ensure authorizations and insurance approvals are in place before services are delivered, supporting timely care, reducing delays, and helping patients better understand their coverage.

We’re looking for someone who enjoys problem-solving, communicating with patients and healthcare teams, and navigating insurance processes with accuracy and compassion. If you thrive in a collaborative environment and want your work to have a direct impact on both patient experience and organizational success, we’d love to meet you.

What You’ll Do

• Help secure authorizations and pre-certifications for inpatient, outpatient, and ambulatory services before care is provided
• Review insurance coverage, benefits, and payer requirements to support accurate reimbursement and minimize denials
• Use electronic eligibility tools, payer portals, and direct communication with insurance companies to verify coverage and determine next steps
• Submit notifications, clinical documentation, and authorization requests within payer timelines and guidelines
• Partner closely with clinical teams, providers, and operations staff to gather needed information and resolve authorization issues quickly
• Communicate clearly and professionally with patients, physicians, insurance representatives, and internal teams regarding authorization status, denials, and next steps
• Escalate complex or urgent cases appropriately to ensure timely resolution and continuity of care
• Maintain knowledge of insurance regulations, managed care guidelines, and Revenue Cycle processes
• Scan, retrieve, and manage documentation within departmental systems and applications
• Participate in team meetings, training, and continuous improvement efforts
• Support department productivity and quality goals while maintaining a strong focus on accuracy and service excellence

What Makes You Successful in This Role

• Strong communication and customer service skills
• Ability to manage multiple priorities in a fast-paced environment
• Attention to detail and confidence navigating insurance and authorization processes
• A collaborative mindset and commitment to supporting patients and care teams
• Comfort working with technology, payer portals, and healthcare systems
• Ability to handle sensitive information with professionalism and confidentiality

Why Join Us

• Meaningful work that directly supports patient access to care
• Collaborative and supportive team environment
• Opportunities to grow your healthcare and Revenue Cycle expertise
• A culture focused on compassion, accountability, and service excellence

Additional Information

• Performs other duties as assigned
• Adheres to all organizational policies, standards, and compliance requirements
• Protects patient confidentiality and maintains compliance with all Protected Health Information (PHI) guidelines, training, and 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%