West Cancer Center & Research Institute · 1 day ago
PreCert Specialist - Full-Time - Germantown, TN
Germantown, TN
Full-time
Onsite
Mid Level
3+ years expWest Cancer Center is a comprehensive, patient-centered cancer care and research institution committed to compassionate care, innovation, and clinical excellence. The PreCert Specialist plays a critical role in ensuring that patients have the required precertification for procedures, drugs, and radiology services while serving as a key resource for navigating insurance requirements and obtaining authorizations.
BiotechnologyEducationHealth CareHospitalMedicalOncology
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
Qualification
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
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
Preferred
Experience with chemotherapy and radiology precertifications
Benefits
Comprehensive benefits package
Company
West Cancer Center & Research Institute
West Cancer Center & Research Institute is proud to be the region’s comprehensive leader in adult cancer care and research.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
James Cagle
Chief Financial Officer
Candace Wilder
Chief Operating Officer
Recent News
Business Wire
2026-01-22
2025-03-16
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