PreCertification Coordinator

This 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 includes 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.
• Obtain pre-certification/preauthorization from insurance companies prior to test or procedure.
• Manage patient insurance verification by utilizing multiple insurance websites, phone, fax, and other methods as needed.
• Timely follow up on all submitted verifications/pre-certifications.
• Notify the physician regarding denials, 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 of 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.