Precertification Specialist

Semmes Murphey Clinic; Memphis (TN); On-site; USD 36,000 - 48,000; Full time

Job summary

Semmes Murphey Clinic in Memphis, TN, seeks a precertification specialist to manage surgical pre-certifications and coordinate with insurers, physicians, and patients to secure timely approvals. You will maintain accurate documentation, support clinical staff, and ensure continuity of quality patient care.

The role requires strong communication skills and attention to detail. The team collaborates with precertification and radiology staff to support efficient authorizations and keep patient care

Qualifications

• High school diploma or equivalent required.
• Two years’ experience in medical registration/admissions, precertification, and/or medical insurance.
• Preferred: Medical assistant certification or Practical Nurse licensure (Nursing Compact).

Responsibilities

• Develop and maintain effective relationships with insurance companies, physicians, and medical office staff.
• Determine necessity for precertification and coordinate with insurance companies, patients and clinical staff to obtain information.
• Obtain and complete all insurance pre-certifications and authorizations, as required, for various surgical procedures.
• Work collaboratively with block precertification and radiology precertification staff; contribute to both block and radiology authorizations as delegated.
• Maintain complete and accurate precertification documentation in patient charts.
• Regular and reliable attendance is required to successfully perform these essential functions.

Skills

Insurance knowledge

Medical terminology

EMR proficiency

Microsoft Office

Communication skills

Customer service

Education

High school diploma or equivalent

Practical Nurse licensure or Nursing Compact state licensure

Tools

EMR software

Microsoft Office Suite

Job description

Semmes Murphey Clinic

Semmes Murphey Clinic's mission is to deliver the best care for people suffering from neurological illness while advancing the field of neuroscience.

Our precertification department is hiring a specialist. This role will primarily work on surgery precertification's. You will work closely with your team and the clinical staff to ensure the timely and efficient pre-cert of SMC procedures or surgeries and assist in providing continuity of quality patient care.

Key Responsibilities

• Develop and maintain effective relationships with insurance companies, physicians, and medical office staff
• Determine necessity for precertification and coordinate with insurance companies, patients and clinical staff to obtain information
• Obtain and complete all insurance pre-certifications and authorizations, as required, for various surgical procedures
• Work collaboratively with block precertification and radiology precertification staff; contribute to both block and radiology authorizations as delegated
• Maintain complete and accurate precertification documentation in patient charts
• Regular and reliable attendance is required to successfully perform these essential functions

Requirements

Minimum:

• High school diploma or equivalent
• Two (2) years’ relevant experience in medical registration/admissions, precertification and/or medical insurance

Preferred:

• Current medical assistant certification or state licensure as a Practical Nurse (or licensure from a state within the Nursing Compact)

Knowledge, Skills, & Abilities

• Proficient knowledge of insurance requirements, medical/clinical terminology, medical necessity associated with various clinical procedure codes, and certification/referral work flow
• Proficient in Microsoft Office (Excel, Outlook, Word)
• Knowledge of internet software and electronic medical records (EMR)
• Effective communication, both oral and written
• Excellent interpersonal skills with the ability to tactfully interact with all levels of the organization
• Ability to provide excellent customer service during difficult or emotional situations
• Ability to manage workflow and prioritize demands
• High level of confidentiality and discretion

Equal Opportunity Employer/Veterans/Disabled

#SMC

Equal employment opportunity, including veterans and individuals with disabilities.