PreCertification Coordinator - Columbia

TOA; Columbia (TN); Sur place; USD 38 000 - 56 000; Plein temps

Avantages offerts par ce poste

Comprehensive benefits package (health

Paid Time Off

Paid Holidays

401k match and profit-sharing

Résumé du poste

Tennessee Orthopaedic Alliance (TOA) seeks a Prec ertification Coordinator to be the friendly face for patients, providers, and carriers. You will verify insurance, obtain pre-certifications, and help schedule procedures across multiple plans.

This role requires knowledge of CPT/ICD-10 coding, EHR experience, and strong organizational skills. TOA offers comprehensive benefits, paid time off, and holidays.

Qualifications

• Understanding CPT and ICD-10 coding.
• Experience with EHR systems such as NextGen.
• Knowledge of coordination of benefits and precertification denial overturns.
• Strong organizational and interpersonal skills.
• Knowledge of medical terminology.

Responsabilités

• Promptly identify errors or issues in precert and test/surgery scheduling.
• Communicate with insurance payer representatives, patients, and staff to ensure timely and accurate surgery scheduling.
• Operate within guidelines and provide backup documentation to carriers.
• Obtain pre-certification/preauthorization from insurance companies prior to test or procedure.
• Manage patient insurance verification via multiple websites, phone, fax, and other methods.
• Timely follow up on all submitted verifications/pre-certifications.
• Notify physicians regarding denials and approvals.

Connaissances

CPT and ICD-10 coding

EHR experience

Organizational skills

Insurance knowledge

Outils

NextGen EHR

Description du poste

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.

W ho 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.

The Precertification Coordinator is the friendly and helpful face of TOA – generally, the first person who interacts with our patients, providers, and carriers.

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
• 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
• 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.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.