Medical Pre-Certification Specialist

3 days ago


Cebu City, Central Visayas, Philippines Tahche Outsourcing Services Inc Full time

At Tahche Outsourcing Services Inc, we are seeking a skilled Medical Pre-Certification Specialist to join our team. As a key member of our operations, you will be responsible for ensuring seamless pre-certifications and pre-authorizations for medical procedures and medications.

This is a full-time role with a US-based schedule and a work-from-office setup. If you have the right skill set and passion for healthcare, this may be your opportunity to grow with a fast-paced organization.

The ideal candidate will possess excellent communication skills, attention to detail, and a solid understanding of the pre-certification process. With at least 6 months of experience in obtaining pre-authorization in a healthcare environment, you will be knowledgeable in CPT codes and DX codes, as well as familiar with different insurance portals and websites.

Key Responsibilities:

  • Monitoring the Radiology Worklist on a daily basis
  • Sorting cases based on priority
  • Verifying insurance coverage and obtaining referrals and authorizations
  • Creating cases in eviCore or other insurance portals as required
  • Requesting additional clinical information as needed
  • Reviewing received clinicals and ensuring they meet insurance guidelines for authorization
  • Tracking pending cases for approval or denial
  • Making follow-ups with insurance companies and clinics on pending/denied cases
  • Taking action on pending cases if additional clinicals, CPT recommendations, or other actions are required
  • Notifying providers or medical assistants about pending or denied cases
  • Performing other tasks assigned by immediate superiors


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