PreCertification Coordinator - Columbia

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.

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
• 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 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

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.