Precertification Specialist

Position Overview

Penn Medicine is dedicated to its mission of providing exceptional patient care, innovative research, and outstanding education. In this role at Clinical Practices of the University of Pennsylvania (CPUP) – Access Center, located at 1500 Market Street, Philadelphia, PA – you will obtain referrals and authorizations for outpatient visits, tests, or procedures, verify eligibility and insurance details, and ensure seamless billing processes. This full-time position plays a vital part in maximizing revenue and supporting operational excellence.

Key Responsibilities

• Maintain up-to-date knowledge of insurance requirements pertinent to patient services and billing procedures.
• Update information in the EMR including demographics, insurance, referrals, and pre-authorizations following UPHS protocols.
• Facilitate maximum revenue for the practice by managing strategies to secure necessary referrals and authorizations from third-party payers.
• Obtain any missing data or information to ensure smooth billing processes.
• Understand insurance and registration details as they relate to various plans and benefits, including the need for referrals and pre-certifications.
• Communicate front end issues that may impact the revenue process to the Manager.
• Respond to correspondence, telephone calls, and inquiries from carriers and patients.

Required Qualifications

• H.S. Diploma/GED (Required)
• 2+ years relevant experience (Required)

Preferred Qualifications

• Bachelor of Arts or Science (Preferred)
• Experience with pre-certifications, referrals, and prior authorizations (Preferred)

Benefits & Perks

• Comprehensive Compensation & Benefits program, including one of the finest prepaid tuition assistance programs in the region.