Precertification Coordinator

Brief Description

Advanced ENT & Allergy, an affiliate of SENTA Partners, is a long-standing member of the Louisville and Southern Indiana healthcare community, provides a highly coordinated and comprehensive delivery of head and neck care.

SENTA Partners is a leading Management Services Organization (MSO) specializing in providing comprehensive support to ENT and Allergy private practices. Our mission is to help people Breathe better, Hear better, Live better. At SENTA, we focus on the operational efficiencies and financial performance of our partner practices, allowing physicians to focus on delivering exceptional patient care. We are committed to fostering a collaborative and supportive work environment where our employees can thrive and grow.

Position Summary

The Precertification Coordinator plays a vital role in ensuring patients receive timely and appropriate care by managing insurance precertification and authorization processes. This position serves as a liaison between patients, providers, and insurance companies, obtaining required approvals, verifying benefits, and ensuring compliance with payer-specific requirements. The coordinator’s work directly impacts patient access to care and the financial health of the organization.

Key Responsibilities

• Review and process precertification requests for medical procedures, surgeries, medications, and diagnostic tests.
• Verify patient insurance coverage, benefits, and eligibility for services.
• Communicate with insurance companies to secure authorizations, resolve coverage issues, and prevent claim denials.
• Coordinate with physicians, nurses, and other clinical staff to gather and submit required documentation.
• Track and monitor authorization requests, ensuring timely follow-up and resolution of pending cases.
• Handle appeals and reauthorization requests for denied claims.
• Maintain accurate records of all precertification activities, approvals, denials, and appeals in electronic health records (EHR) or practice management systems.
• Provide patients with clear and compassionate explanations of their insurance benefits and precertification requirements.
• Collaborate with the billing department to ensure accurate claim submission and payment processing.
• Stay current on insurance policies, payer guidelines, and healthcare regulations.
• Provide support and training to staff on precertification processes and payer-specific requirements.
• Ensure strict compliance with HIPAA and patient confidentiality standards.
  
  
  

What We Offer

• Comprehensive Health Benefits (Medical, Dental, and Vision)
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• Short & Long Term Disability
• Holidays & Paid Time Off (PTO)
• Employee Assistance Program (EAP)
• Retirement Contribution Program - 401(K) Match
• Clinic Hours:
• Monday-Friday
• No Weekends!
  

Requirements

Qualifications

• High school diploma or equivalent required; associate’s or bachelor’s degree in healthcare administration or a related field preferred.
• Minimum 1–2 years of experience in medical precertification, insurance verification, or related healthcare role.
• Strong knowledge of health insurance plans, including Medicare, Medicaid, and commercial payers.
• Proficiency in medical terminology, CPT coding, ICD-10 coding, and payer-specific requirements.
• Understanding of healthcare reimbursement processes.
• Excellent communication, customer service, and problem-solving skills.
• Strong organizational skills with the ability to manage multiple priorities and deadlines.
• Proficiency with EHR systems, practice management software, and insurance portals.
• Ability to work independently and collaboratively in a fast-paced environment.
  
  
  

Summary

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• Certain US jurisdictions require SENTA Partners to provide new employees with a reasonable estimate of the salary for this role at the location in which the job may be performed. The posted salary range reflects our best estimate at the time of posting, though it's important to remember that actual salaries may vary. Factors that determine the final salary offer include office location, experience, skills, and current organizational needs.
• SENTA Partners is an equal opportunity employer and considers all qualified applicants for employment without regard to race, color, religion, sex, national origin, disability, veteran status, sexual orientation, gender identity, or any other protected status.