precertification coordinator

Parkridge Health System

<div><h5 class="jobSectionHeader">Introduction</h5>
This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).
Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for the opportunity below: Precertification Representative Work from Home<h5 class="jobSectionHeader">
Benefits</h5>
Parallon offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:<ul><li>
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.</li><li>
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.</li><li>
Free counseling services and resources for emotional, physical and financial wellbeing 
</li><li>
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) 
</li><li>
Employee Stock Purchase Plan with 10% off HCA Healthcare stock 
</li><li>
Family support through fertility and family building benefits with Progyny and adoption assistance. 
</li><li>
Referral services for child, elder and pet care, home and auto repair, event planning and more 
</li><li>
Consumer discounts through Abenity and Consumer Discounts 
</li><li>
Retirement readiness, rollover assistance services and preferred banking partnerships 
</li><li>
Education assistance (tuition, student loan, certification support, dependent scholarships) 
</li><li>
Colleague recognition program 
</li><li>
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) 
</li><li>
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.</li></ul>
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location. 
We are seeking a Precertification Representative for our team to ensure that we continue to provide all patients with high quality, efficient care. Did you get into our industry for these reasons? We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply!<h5 class="jobSectionHeader">
Job Summary and Qualifications</h5> 
The Precertification Representative is responsible for requesting, obtaining and following up on authorization requests. Requests and interdepartmental scheduling with minimal delay to customer. Correct utilization of all systems and accurately enters all mandatory information. Provides instructions to patients and physician&rsquo;s staff on authorization requirements and information. Establish and maintain a working knowledge and vocabulary of scheduled procedures. Manage daily operations including but not limited to: Meditech, Orders Management System, Call Center Equipment (phones, etc.), payer websites. 
In this role you will: 
<ul><li>
Requests, obtains and follows up on authorization requests
</li><li>Processes Phoned and/or faxed requests processed in a prompt and timely manner</li><li>
Stat requests and interdepartmental scheduling processed promptly;</li><li>
Contacts the facilities, physicians&rsquo; offices and/or insurance companies to resolve denials/appeals</li><li>
Schedules patient tests, and/or procedures in a prompt, courteous manner;</li><li>
Correctly utilizes the features of the Meditech system and accurately enters necessary information;</li><li>
Instructs patients and physician staff on authorization, test preparation and registration information;</li><li>
Establishes and maintains a working knowledge and vocabulary of procedures scheduled;</li><li>
Demonstrates the willingness and ability to process requests for diagnostic procedures and coordinates the Peer to Peer function as needs arise</li><li>
Checks patient orders for compliance with Medicare guidelines</li><li>
Processes physician&rsquo;s orders in accordance with department standards</li><li>
Assists with orientation of new employees as needed and serves as a resource within the department;</li><li>
Displays confidence when processing difficult or interdepartmental requests;</li><li>
Recognized by customers as knowledgeable and helpful</li></ul> 
Qualifications: 
<ul><li>
High school diploma or GED preferred.</li><li>
One year of precertification experience preferred</li><li>
Previous Call Center Experience preferred</li><li>
Meditech experience a plus</li><li>
Virtual Employees are required to have wired High Speed Internet Speed 25 MBS Download and15MBS Upload</li><li>
Remote employees are required to live within 60 miles of an HCA hospital.</li></ul>
Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. 

&quot;Good people beget good people.&quot;- Dr. Thomas Frist, Sr. 
HCA Healthcare Co-Founder
We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Precertification Representative PRN opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</div>

Precertification Representative PRN

HCA Florida North Florida Hospital​

HCA Houston Healthcare

LewisGale Regional Health System

Medical City Healthcare

Elevance Health

<div>Job ID:JP00046432
Anticipated Start Date: 05/13/2026
Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.
Elevance Health is a health company dedicated to improving lives and communities &ndash; and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Responsible for coordinating cases for precertification and prior authorization review.
Primary duties may include, but are not limited to:<ul><li>
Managing incoming calls or incoming post services claims work.
</li><li>Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.</li><li>
Refers cases requiring clinical review to a Nurse reviewer.
</li><li>Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.</li><li>
Responds to telephone and written inquiries from clients, providers and in-house departments.
</li><li>Conducts clinical screening process.
</li><li>Authorizes initial set of sessions to provider.
</li><li>Checks benefits for facility based treatment.
</li><li>Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.</li></ul>
Requirements:<ul><li>
Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
</li><li>Associates will need to review service details and enter the authorization in our system and electronically send a confirmation letter to the provider. Associates will need to review our fax queues and pend a line in our UM system.</li><li>
Medical terminology training and experience in medical or insurance field preferred.
</li><li>Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.</li></ul>
Job Type: Contract Opportunity only
Additional Details:<ul><li>
100% remote.
</li><li>Monday - Friday 8 AM-5 PM EST. - NO OVERTIME / NO WEEKEND</li></ul>
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
About BCForward:
Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.
BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.
BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.
To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.
This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration. employed
<div>Benefits Information
BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.
The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. This does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).</div></div>

Utilization Management Rep I (contract)

<div>Job ID:JP00046432
Anticipated Start Date: 05/13/2026
Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.
Elevance Health is a health company dedicated to improving lives and communities &ndash; and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Responsible for coordinating cases for precertification and prior authorization review.
Primary duties may include, but are not limited to:<ul><li>
Managing incoming calls or incoming post services claims work.
</li><li>Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.</li><li>
Refers cases requiring clinical review to a Nurse reviewer.
</li><li>Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.</li><li>
Responds to telephone and written inquiries from clients, providers and in-house departments.
</li><li>Conducts clinical screening process.
</li><li>Authorizes initial set of sessions to provider.
</li><li>Checks benefits for facility based treatment.
</li><li>Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.</li></ul>
Requirements:<ul><li>
Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
</li><li>Associates will need to review service details and enter the authorization in our system and electronically send a confirmation letter to the provider. Associates will need to review our fax queues and pend a line in our UM system.</li><li>
Medical terminology training and experience in medical or insurance field preferred.
</li><li>Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.</li></ul>
Job Type: Contract Opportunity only
Additional Details:<ul><li>
100% remote.
</li><li>Monday - Friday 8 AM-5 PM EST. - NO OVERTIME / NO WEEKEND</li></ul> 
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. 
About BCForward:
Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally. 
BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work. 
BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability. 
To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process. 
This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.
<div>Pay Rate Range
13.12 - 23.8 USD hourly
</div><div>Additional Notes
The pay range is the range BCForward in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations.
</div><div>Benefits Information
BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.
The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. This does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).</div></div>

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Precertification Representative PRN

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Precertification Representative PRN

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Utilization Management Rep I (contract)

Utilization Management Rep I (contract)