Precertification Specialist

Elite Sports Medicine Orthopedics is looking for a Precertification Specialist with a strong sense of ownership, attention to detail and able to multi-task. The Percertification Specialist job is to ensure all services in the following categories (Surgery, MRI/CT, Injections or DME) have pre-authorization that patients are eligible for their appointment. The Precertification Specialist will work the denials and appeals for the same service and product in a timely and efficiently manner. The training is set to take place at our Midtown location and then this position would be FULLY-REMOTE!

YOU MUST LIVE IN THE STATE OF TENNESSEE to apply for this position.

Elite Sports Medicine Orthopedics offers a competitive compensation package for full-time members including: Three Medical Plans Options (your choice of a PPO or HDHP), Dental and Vision Coverage, Health Savings Account (with HDHP), Employee Assistance Program, Company Provided Basic Life, AD&D and Long-Term Disability, Voluntary Life and Short-Term Disability, PTO Accrual, Paid Holidays, and 401(k) employer match.

MINIMUM ESSENTIAL JOB REQUIREMENTS

• Review appointments and or surgery schedule once week ahead of time to determine which patients need referral authorization for upcoming visits
• Obtain referral authorizations either by using online applications or by contacting each patient’s insurance company
• Maintain organized working files of all referral authorizations and enter authorization numbers into the system when applicable.
• Document all discussions with insurance companies and patients
• Coordinate with patient all financial responsibilities and facilitate reschedule when needed
• If Durable Medical Equipment (DME) is ordered, obtain authorization number or refer patient to a preferred provider as dictated by insurance plan
• Obtain referral numbers to follow-up visits if necessary, for HMO established patients
• Obtain authorization number for MRI/CT’s if assigned to that certification
• Obtain authorization number for surgeries if assigned to that certification

KNOWLEDGE, SKILL AND COMPETENCY REQUIREMENTS

• High school diploma required
• College education or trade school preferred
• Knowledge of medical practice procedures and terminology preferred
• Experience working in a physician office or hospital billing positions preferred
• Proven record of discussing financial responsibilities and establishing payment plans as necessary
• Knowledge of billing and collections procedures
• Knowledge of CPT and ICD-100-CM coding
• Knowledge of commercial insurance, Medicare, and Medicaid reimbursement
• Proven understanding of Explanation of Benefits forms, claim forms and insurance billing process
• Comfortable using email and interacting in various applications
• Orthopedic claims experience is preferred
• Knowledge of MS Office Suite including MS Word, MS Excel, and MS Outlook
• Excellent written and verbal communication abilities
• Strong attention to detail and goal oriented

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, sexual orientation, age, disability, gender identity, marital or veteran status, or any other protected class.