Psych-Pre-cert Specialist

WE ARE INSIGHT:At Insight Hospital and Medical Center- Chicago, we believe there is a better way to provide quality healthcare while achieving health equity. Our Chicago location looks forward to working closely with our neighbors and residents, to build a full-service community hospital in the Bronzeville area of Chicago; creating a comprehensive plan to increase services and meet community needs. With a growing team that is dedicated to delivering world-class service to everyone we meet, it is our mission to deliver the most compassionate, loving, expert, and impactful care in the world to our patients. Be a part of the Insight Chicago team that provides PATIENT CARE SECOND TO NONE! If you would like to be a part of our future team, please apply now!Position Summary The Psychiatric Pre-Certification Specialist is responsible for securing insurance authorizations for psychiatric services to ensure patients can access critical mental health and substance use treatment without financial barriers. This role serves as the initial point of contact with payers, obtaining pre-certifications for various levels of psychiatric care and supporting the Utilization Review team with authorization tracking and documentation. The Pre-Cert Specialist ensures timely submission of authorization requests, accurate documentation in required systems, and effective communication with clinical teams and insurance providers. Key Responsibilities Pre-Certification & Authorization Obtains pre-certifications for psychiatric-specific services Verifies behavioral health coverage for various payers, including Medicaid, Medicare Advantage, and commercial insurance plans Applies InterQual and MCG behavioral health criteria to validate medical necessity using psychiatric evaluations and treatment plans Advocates with insurance providers to secure approval for psychiatric admissions Documentation & Systems Management Documents all pre-certification activities and authorization decisions in systems Utilizes psychiatric ICD-10 codes and CPT codes appropriately Maintains accurate records of all pre-certification requests, approvals, and denials Tracks authorization status and updates required systems in a timely manner Collaboration & Communication Collaborates with psychiatrists, crisis team members, and utilization coordinators on urgent authorization needs Communicates pre-certification status and next steps to appropriate team members Participates in team discussions regarding authorization requirements and payer trends Escalates complex or urgent cases to supervisor immediately Support for Utilization Review Team Assists Utilization Coordinators with: Psych concurrent review tracking Entering authorization updates in UR systems Preparing simple appeal documentation Researching payer policies for behavioral health coverage Provides backup support for UR tasks as needed Ensures smooth handoff between pre-certification and concurrent review processes Time-Sensitive Communication Monitors and responds to incoming calls from payers, providers, and internal departments in a timely manner Processes incoming faxes related to authorizations throughout the day Ensures no voicemail or fax goes unaddressed beyond 24 hours Escalates urgent issues to supervisor immediately Compliance & Regulatory Knowledge Maintains knowledge of behavioral health insurance guidelines for Medicaid, Medicare Advantage, and commercial plans Understands and applies psychiatric terminology, DSM-5 diagnoses, levels of care, and ASAM criteria for SUD treatment Ensures compliance with mental health parity laws and HIPAA regulations Maintains confidentiality of all patient information Qualifications Education Requirements High School Diploma required Associate or Bachelor's degree in healthcare administration, Psychology, Social Work, or related field preferred Relevant experience may be considered in lieu of degree Experience Minimum 2 years of experience in one or more of the following: Behavioral health pre-certification Psychiatric utilization review Psychiatric billing or authorizations Experience with behavioral health insurance guidelines (Medicaid/Medicare Advantage, commercial plans) required Familiarity with psychiatric terminology, DSM-5, levels of care, and ASAM criteria for SUD required Experience with psych EMRs (Cerner preferred) Knowledge of Illinois Medicaid managed care plans preferred De-escalation skills for high-stakes insurer negotiations preferred Knowledge, Skills & Abilities Knowledge Working knowledge of behavioral health insurance guidelines and authorization processes Understanding of psychiatric diagnoses, levels of care, and treatment modalities Familiarity with InterQual/MCG criteria for behavioral health Knowledge of mental health parity laws and HIPAA requirements Skills Strong organizational skills and attention to detail Excellent verbal and written communication skills for interacting with payers and clinical teams Ability to advocate effectively with insurance providers Proficiency with electronic medical records (Cerner preferred) and Microsoft Office (Outlook, Excel, Word) Critical thinking and problem-solving abilities Ability to prioritize multiple tasks and respond to time-sensitive requests Abilities Ability to work independently and manage own caseload Capacity to remain focused despite frequent interruptions (calls, emails, faxes) Ability to collaborate effectively with psychiatrists, crisis teams, and utilization coordinators Flexibility to adapt to changing payer requirements and priorities Commitment to accuracy and thorough documentation Ability to maintain professionalism during high-stakes insurer negotiations Working Conditions Full-time position, Monday-Friday, with potential for occasional extended hours based on patient needs Work is performed in an office setting within a hospital environment May require sitting for extended periods while completing computer-based tasks Frequent telephone and computer use Regular collaboration with clinical teams and external payers Benefits: Paid Sick Time - effective 90 days after employment Paid Vacation Time - effective 90 days after employment Health, vision & dental benefits - eligible at 30 days, following the 1st of the following month Short and long-term disability and basic life insurance - after 30 days of employmentInsight Employees are required to be vaccinated for COVID-19 as a condition of employment, subject to accommodation for medical or sincerely held religious beliefs. Insight is an equal opportunity employer and values workplace diversity!

Created: 2026-04-15