Pre-Certification Coordinator
2 weeks ago
Job Type
Full-time
Description
Remote Position
Tennessee Orthopaedic Alliance is one of the nation's largest orthopedic networks. TOA offers comprehensive medical and surgical treatment of bone, joint and soft tissue disorders. Our treatment is compassionate, conservative and prompt, providing patients with the specialized orthopedic care they deserve.
There are numerous reasons why TOA is an employer of choice; here are a few of them:
• Stability and Growth - TOA promotes long-term employment in positions as well as growth opportunities for those who want to further their career goals.
• Impact - TOA's team members use our careers - whether in our clinics or our business office - to make a positive difference in the community by building relationships and positively impacting patient lifestyles.
• Work Environment - The TOA team focuses on cultivating an excellent working environment; one of positivity, collaboration, job satisfaction, and engagement.
• Total Rewards - TOA offers competitive salaries based on the current East Tennessee wage market, plus a comprehensive benefit package, including Medical, Dental, Paid Time Off, Extended Illness Bank and more. Our 401(k) plan provides a company match, safe harbor match and profit-sharing match to go along with your contributions.
The Pre-cert Coordinator is an important link in the TOA revenue cycle effort. The efforts of the pre-cert team help determine if a procedure is covered, paid, or denied. The ideal candidate will be highly organized, detail oriented, team-first mindset, self-motivation, and ability to function in a fast-paced atmosphere, can work independently and with a team.
Responsibilities include:
• Obtain pre-certification/preauthorization from insurance companies prior to each procedure.
• Submit all required documentation needed to obtain pre-certification via insurance websites
• Timely follow up on all submitted pre-certifications
• Prioritize the procedures by date order along with the date of procedure
• Notify the appropriate physician teams regarding denials, P2P options, and approvals
Requirements:
• College is preferred, and a high school diploma or equivalent is required.
• Reside in the state of Tennessee
• At least 3 years pre-certification experience is preferred, with some experience in an orthopaedic practice a plus
• Exceptional customer service and patient focus.
• Knowledge of Insurance - particularly coordination of benefit rules and precertification denial overturns are essential to this position.
• Knowledge of administrative and clerical procedures, including experience with computer systems/Excel. Experience with an EHR or NextGen is a plus
• Understanding of CPT and ICD-10 coding
TOA is an equal opportunity employer. TOA conducts background checks on applicants who accept employment offers.
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