Pre-Certifictaion Coordinator I - Single Business Office - Full Time

Every authorization you obtain helps move patient care forward. As a Pre-Certification Coordinator I , you'll collaborate with providers, insurance companies, and patients to ensure timely approvals that support exceptional care and positive outcomes. Why Choose Guthrie: Voluntary 403(b) Retirement Plan – Plan for your future with Fidelity investment options Employee Assistance Program – Confidential support for personal and professional well-being Shift Differentials & Premiums – Earn more for evenings, nights, weekends, and float coverage PTO Starts on Day 1 Friendly, Inclusive Work Family – Be part of a team that feels like home Recognized as a Top Healthcare Employer: Guthrie is consistently recognized for its strong workplace culture and commitment to caregiver well ‑ being, including: Best Places to Work 2025 - Modern Healthcare America's Greatest Workplaces in Healthcare 2025, 2026 - Newsweek America's Best-In-State Employers (PA) 2025 - Forbes America's Best Employers for Healthcare Professionals 2025 - Forbes America's Best Employers for Women 2025 – Forbes Schedule & Coverage: Full Time, Day Shift, Hybrid work setting Position Summary Under general supervision, performs standardized authorization and financial clearance activities for Guthrie. This position focuses on routine to moderately complex authorization tasks, payer communications, and documentation while following established workflows, payer guidelines, and departmental procedures. Maintains an initial prior authorization & eligibility denial rate below 7%. Position Requirements High School Diploma or equivalent Proficiency with computers and online portals Excellent communication skills Ability to function as a cooperative and positive team member Experience & Skills Basic knowledge of prior authorization and insurance terminology Strong attention to detail Ability to follow established procedures Effective written and verbal communication skills Scope & Complexity Handles routine and standardized authorization workflows Works within clearly defined payer rules and protocols Escalates complex issues, denials, or exceptions to senior staff or leadership Requires guidance for nonstandard cases Essential Functions Insurance Verification & Coverage Support Verifies insurance eligibility and benefit coverage prior to scheduled services using Epic and Payer Portals. Confirms active coverage dates, plan requirements, and authorization dependencies to ensure services are financially cleared. Performs eligibility rechecks as needed when service dates change; coverage appears inactive, or payer responses require validation. Identifies discrepancies in coverage or eligibility and escalates issues per established workflows. Documents eligibility verification and benefit details accurately in the electronic health record. Authorization & Coverage Activities Obtains initial insurance authorizations for all admissions and visits including notice of admission for elective IP stays and all VA admissions, including ER and OBS as applicable. Submit authorization requests using payer portals, fax, or phone based on defined requirements. Enters authorization numbers and coverage details into the electronic health record. Reviews schedules to confirm authorization coverage supports planned services. Follow up on pending authorizations using established timelines. Documentation & Communication Documents payer determination accurately and timely. Communicates authorization status to clinical staff and case management. Notifies leadership of authorization delays or missing information. Maintains complete and compliant patient account documentation. Systems & Tools Uses Epic, payer portals, and standard office applications. Works assigned work queues and portals under supervision. Follows departmental workflows and documentation standards. Other Duties Other duties as assigned. The pay rage for this position is $18.27-$28.50/hr. based on experience. #LI-MD1 Area Level I Level II Knowledge Basic authorization knowledge Advanced payer and authorization expertise Work Style Follows procedures Works independently, prioritizes complexity Problem Solving Escalates issues Resolves complex issues Leadership None Mentors peers