Job Description

Job Description

Job Description

Precertifier Team Member

Contract: 09/08/2026 to 03/07/2027
Location: 325 Broad St, Sumter, SC 29150 / Remote
Position Type: Healthcare Administration
Allmed Benefits: Vision, Health, Dental Insurance and 401(k)
Schedule : Bussiness Hours
Pay: $13.50/hr (Paid Weekly)

The Precertifier Team Member is responsible for obtaining prior authorizations and pre-certifications for diagnostic testing, procedures, medications, and specialty treatments. This position works closely with providers, patients, insurance companies, and ancillary departments to help ensure timely access to medically necessary services while meeting insurance and organizational requirements.

Essential Duties & Responsibilities

• Obtain prior authorizations and pre-certifications for diagnostic testing, procedures, medications, and specialty treatments, including:
  • MRI
  • CT Scans
  • Stress Tests
  • Ultrasounds
  • Nerve Conduction Studies
  • Vestibular Testing (VNG)
  • Botox Treatments
  • Specialty and injectable medications
• Verify patient insurance benefits and authorization requirements.
• Submit clinical documentation and medical records to insurance carriers as required.
• Monitor authorization requests and follow up with payers to obtain timely decisions.
• Communicate approvals, denials, and pending requests to providers, clinical staff, and patients.
• Review denial determinations and coordinate appeals when appropriate.
• Maintain accurate documentation of authorization requests and outcomes within the EMR.
• Ensure authorization activities comply with payer guidelines and organizational policies.
• Collaborate with physicians, nurses, and ancillary departments to obtain necessary clinical information.
• Track authorization expiration dates and obtain extensions when necessary.
• Provide professional customer service while maintaining patient confidentiality and HIPAA compliance.

Required Qualifications

• High school diploma or equivalent.
• Strong organizational and time-management skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities in a fast-paced healthcare environment.
• Strong attention to detail and follow-through.
• Ability to work independently and as part of a team.
• Understanding of patient confidentiality and HIPAA requirements.

Preferred Qualifications

• Associate degree.
• Previous experience with prior authorizations, pre-certifications, or medical insurance verification.
• Healthcare administration experience.
• Knowledge of medical terminology and diagnostic testing.
• Experience with specialty medication authorization processes.
• Familiarity with EMR systems and insurance payer portals.

Core Competencies

• Prior Authorization & Insurance Knowledge
• Attention to Detail
• Critical Thinking & Problem Solving
• Time Management
• Customer Service
• Organization
• Communication
• Team Collaboration
• Ability to Work Independently

Work Location

The position may be based at the Sumter, SC office at 325 Broad Street or performed remotely, depending on business needs and eligibility for remote work.

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