Job Title: PreCert Specialist
About Us
West Cancer Center is a comprehensive, patient-centered cancer care and research institution committed to compassionate care, innovation, and clinical excellence. Our multidisciplinary teams deliver integrated care tailored to the needs of each individual and their loved ones.
Position Overview
The PreCert Specialist plays a critical role as the front-line defense ensuring that patients have the required precertification for procedures, drugs, and radiology services. This position is also responsible for entering patient information into the system. The PreCert Specialist serves as a key resource for patients, providers, and staff by navigating insurance requirements, obtaining authorizations, and ensuring accurate documentation.
Key Responsibilities
- Verify demographic and insurance information including co-pays, deductibles, stop losses, guarantors, subscribers, and medical policy requirements
- Update demographic and insurance records in a timely and accurate manner
- Obtain and review physician orders for medical necessity and coverage requirements
- Research insurance coverage criteria using payer policies, medical literature, and compendiums
- Generate and review computer-based appointment reports
- Communicate proactively with medical teams to ensure criteria are met for authorization
- Obtain and review authorizations to ensure appropriate payment on the backend
- Review self-pay patients, confirm status, and coordinate with patient assistance programs if applicable
- Support appeals and peer-to-peer requests for precertification denials
- Assist medical teams with cases returned from the office site team to resolve issues
- Maintain compliance with policies, procedures, and performance standards
- Other duties as assigned
Qualifications
Education & Experience
Required:
- High school diploma or equivalent
- Minimum three years’ experience in healthcare insurance or medical clinic, with emphasis on obtaining precerts/predeterminations
- Experience reviewing medical necessity, payer policies, and medical coverage criteria
- Experience in high-volume medical clinic or healthcare environment
Preferred:
- Experience with chemotherapy and radiology precertifications
Skills & Abilities
- Strong knowledge of managed care, medical terminology, precert processes, and insurance claims processing
- Familiarity with coding systems (ICD-9, ICD-10, CPT, HCPCS) for chemotherapy precertification requests
- Proficiency with Microsoft Office applications and multiple healthcare systems/websites
- Excellent navigational skills using intranet and internet resources
- Strong organizational skills with ability to handle high patient volumes
- Excellent problem-solving skills and high attention to detail
- Strong written and verbal communication abilities
- Knowledge of clinical coverage guidelines and medical policies
Why West Cancer Center is a Great Place to Work
- Meaningful Impact: Play a direct role in supporting patients through one of the most challenging times of their lives.
- Collaborative Culture: Work alongside a multidisciplinary team of dedicated professionals committed to improving cancer care.
- Professional Development: Benefit from ongoing training, educational resources, and growth opportunities.
- Mission-Driven Environment: Be part of an organization guided by compassion, integrity, and innovation.
No nights, weekends, or holidays. Comprehensive benefits package.
Join Us
If you’re a detail-oriented professional with a strong knowledge of healthcare insurance and precertification processes, we invite you to apply and join our mission-driven team at West Cancer Center.