PreCertification Coordinator

Tennessee Orthopaedic Alliance; Knoxville (TN); On-site; USD 25,000 - 39,000; Full time

Job summary

Tennessee Orthopaedic Alliance (TOA) is the largest orthopaedic surgery group in Tennessee, with more than 35 locations. We are seeking a precertification/authorization specialist to support patient access and streamline referrals.

You will verify benefits with insurers, obtain authorizations, correct any precert issues, and coordinate with physicians, staff, and patients to ensure timely approvals. TOA upholds Trust, Respect, Honesty, Teamwork, Communication, Diversity, and Accountability as

Qualifications

• Understanding of CPT and ICD-10 coding.
• Experience with EHR (NextGen) is a plus.
• Knowledge of insurance rules and precertification denials.
• Strong organizational and interpersonal skills.
• Understanding medical terminology.

Responsibilities

• Identify errors in precert and diagnostic testing.
• Communicate with insurer representatives, patients and staff to obtain authorizations.
• Provide backup documentation to carriers within guidelines.
• Obtain pre-certification/preauthorization from insurers before tests or procedures.
• Manage patient insurance verification via multiple channels.
• Follow up on all verifications/pre-certifications.
• Notify physicians regarding denials/approvals.

Skills

CPT & ICD-10 knowledge

Insurance coordination

Organizational skills

Interpersonal skills

Medical terminology

Tools

NextGen EHR

Job description

Tennessee Orthopaedic Alliance (TOA) is the largest orthopaedic surgery group in Tennessee, with more than 35 locations across the state. Our commitment to Trust, Respect, Honesty, Teamwork, Communication, Diversity, and Accountability guides how we work and how we care for our patients and communities.

Who we are defines how we care:

• Culture: A shared commitment to Trust, Respect, Honesty, Teamwork, Communication, Diversity, and taking accountability for our own actions with the belief that every one of us makes a difference.
• Patient Access: Setting the standard for orthopedic care in Tennessee with access to over 35 locations across the state, including Ambulatory Surgery Centers.
• Patient Experience: Building strong and authentic relationships with our patients and communities by unifying through consistent collaboration to deliver exceptional patient experiences.
• Financial Stewardship: Using sound judgement to make responsible financial decisions; minimizing waste and maximizing value.

Responsibilities

• Promptly identify any errors or other issues in precert and diagnostic testing.
• Communicate with insurance payer representatives, patients, and employees to obtain timely and accurate authorizations . 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
• 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

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.

Equal Opportunity Employer
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