Clinical Pre-Certification Support Specialist

Job Title: Clinical Pre-Certification Support Specialist

Location: Boardman, OH

Schedule: Full-time, Monday–Friday

About Southwoods Health:

At Southwoods, it’s not just about the treatment, but how you’re treated. We are a leading healthcare provider in northeast Ohio committed to personalized, top-quality care. Join our team and help us maintain the highest standards of medical expertise.

Position Summary:

The Clinical Pre-Certification Support Specialist assists our RN team by securing insurance authorizations for inpatient stays, procedures, medications, and imaging. You will act as a vital link between insurance payers and physician offices to ensure accurate billing and timely patient care.

Key Responsibilities:

• Authorization Management: Obtain, track, and extend clinical authorizations from various insurance carriers in a timely manner.
• Verification: Confirm that registration statuses and procedure codes (CPT) align with authorizations to ensure maximum reimbursement.
• Clinical Review: Assess medical necessity using patient history and insurance guidelines; handle urgent authorization requests as needed.
• Problem Solving: Resolve eligibility issues and communicate potential benefit or payer verification hurdles to pertinent staff.
• Documentation: Maintain accurate data within the Electronic Medical Record (EMR) and other databases while ensuring strict patient confidentiality.
• Compliance: Follow all federal, state, and regulatory guidelines.

Qualifications:

• Experience: Minimum of 2 years experience pre-authorizing inpatient stays and outpatient observations. Insurance verification experience is preferred.
• Credentials: Licensed LPN or Certified Medical Assistant preferred.
• Skills: Strong attention to detail, effective communication, and the ability to problem-solve.
• Professionalism: Must maintain high ethical standards and a professional demeanor at all times.

Apply Today: www.southwoodshealth.com

#SWH