Pre-Certification Specialist (3077)

Position Summary:

The Pre-Certification Specialist verifies patient insurance benefits and secures required authorizations to support the timely and compliant delivery of clinical services at Trinity Health. This role reviews payer guidelines, coordinates closely with clinical departments, and communicates with insurance companies to ensure hospital stays and outpatient services are authorized appropriately. Working as part of a collaborative revenue cycle and care coordination team, the Pre-Certification Specialist helps minimize reimbursement risk by obtaining accurate and complete pre certifications. Through attention to detail, clear communication, and dependable follow-through, this position contributes to efficient operations and supports a positive patient experience by ensuring financial processes are handled promptly and accurately.

Key Responsibilities:

Verify insurance eligibility and coverage for scheduled and unscheduled services using payer websites, electronic systems, and direct communication with insurance representatives.
Obtain required authorizations for inpatient admissions, extended stays, outpatient procedures, and diagnostic testing in accordance with each payer’s rules.
Document authorization details accurately and promptly in the appropriate Trinity Health systems to support billing and clinical workflows.
Communicate with clinical departments, schedulers, providers, and the Business Office to clarify requirements and resolve authorization-related issues.
Monitor high-volume workloads, prioritize tasks, and follow up on pending authorizations to ensure timely completion.
Maintain working knowledge of payer policies, CPT/ICD-10 coding concepts, and medical terminology to support accurate precertification activities.