Job Application for PreCert Specialist- Full-Time- Germantown, TN at West Cancer Center

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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.

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PreCert Specialist- Full-Time- Germantown, TN

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