PreCertification Coordinator - Columbia

Toa; Columbia, Northern (TN, KY); On-site; USD 48,000 - 72,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401k matching

Discretionary profit-sharing

Paid Time Off

Paid Holidays

Job summary

Tennessee Orthopaedic Alliance in Columbia, TN is hiring for a full-time, onsite administrative position focused on precertification, scheduling, and insurance verifications. The role supports physicians and patients by ensuring timely and accurate surgery scheduling and documentation.

The ideal candidate will understand CPT/ICD-10 coding, be proficient with NextGen EHR, and possess strong organizational and interpersonal skills to coordinate with payers and care teams.

Qualifications

• Understanding CPT and ICD-10 coding requirements.
• Knowledge of administrative procedures and precertification processes.
• Familiarity with insurance coordination rules and denial overturns is essential.
• Strong organizational and interpersonal skills are necessary for this role.

Responsibilities

• Identify errors in precert and scheduling processes.
• Communicate with insurance payer representatives, patients, and staff to verify schedules.
• Provide backup documentation to carriers as required by guidelines.
• Obtain pre-certification/preauthorization for tests or procedures.
• Manage patient insurance verification via multiple channels.
• Follow up on all verifications and precertifications in a timely manner.

Skills

CPT/ICD-10 coding

Insurance coordination

Medical terminology

Communication skills

Tools

NextGen EHR

Job 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
• 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.