Pre-Certification Coordinator

Description

This position is a full-time, permanent onsite non-clinical position within Tennessee Orthopaedic Alliance in Columbia, TN. 

Responsibilities

• Promptly identify any errors or other issues in precert and test/surgery scheduling.
• Communicate with insurance payer representatives, patients, and employees to ensure timely and accurate surgery schedule.      This would include Commercial plans, Medicare/Medicare HMO plans, Medicaid/Medicaid HMO plans, and BCBSTN, etc.
• Operate within established guidelines and protocols, including providing backup documentation such as office notes, test reports, etc. to carriers. 
• Obtains pre-certification/preauthorization from insurance companies prior to test      or procedure
• Manages patient insurance verification by utilizing multiple insurance websites, phone, fax, and other methods as needed
• Timely follow up on all submitted verifications/pre-certifications
• Notifies the physician regarding denials, and approvals, etc.

Requirements

• Understanding of CPT and ICD-10 coding
• Prior Precert experience
• Knowledge of administrative and clerical procedures experience with an EHR or NextGen is a plus
• Knowledge of Insurance – particularly coordination of benefit rules and precertification denial overturns are essential to this position.
• Strong organizational and interpersonal skills
• Understanding medical terminology

Benefits

• Competitive pay
• Comprehensive benefits package including medical, dental, vision, 401k match with employee contribution and discretionary profit-sharing
• Paid Time Off (which increases with years of service)
• Paid Holidays

TOA is an equal opportunity employer. TOA conducts drug screens and background checks on applicants who accept employment offers. TOA adheres to HIPAA and OSHA safety guidelines.