Medical Assistant and Precertification Specialist

TOA Columbia • Columbia, TN

54d

About The Position

Precertification Specialist Duties Promptly identify and resolve errors or issues related to precertification and test/surgery scheduling. Communicate with insurance payer representatives, patients, and employees to ensure timely and accurate scheduling for surgeries and procedures (including Commercial plans, Medicare/Medicare HMO, Medicaid/Medicaid HMO, BCBSTN, etc.). Operate within established guidelines and protocols, including submitting required documentation (office notes, test reports, etc.) to insurance carriers. Obtain pre-certification/pre-authorization from insurance companies prior to tests or procedures. Manage patient insurance verification using insurance websites, phone, fax, and other available methods. Perform timely follow-up on all submitted verifications and pre-certifications. Notify physicians promptly regarding denials, approvals, or related updates. Communicate effectively and professionally with patients, physicians, and staff. Medical Assistant Duties Escort patients from the waiting room to exam rooms in a courteous manner. Collect and record patient medical histories, vital signs, medication information, and allergies in the electronic health record (EHR). Assist providers during patient examinations and procedures, including cast, splint, suture, and dressing removal, as well as injections and aspirations. Update patient charts during visits, accurately documenting histories, physical exams, treatment plans, and provider notes using medical terminology and abbreviations. Enter E&M/CPT codes and submit charges to the coding department. Provide clear care plan instructions and patient education, including reviewing home exercise programs. Review charts for completeness and accuracy. Clean and sanitize exam rooms between patients to maintain a safe and welcoming environment.

Requirements

• Prior precertification experience.
• Strong understanding of CPT and ICD-10 coding.
• Knowledge of insurance rules, particularly coordination of benefits and overturning precertification denials.
• Familiarity with administrative and clerical procedures.
• Experience with NextGen or other electronic health record (EHR/EMR) systems (preferred).
• Strong organizational and interpersonal skills.
• Knowledge of medical terminology.
• Ability to thrive in a fast-paced environment.
• Excellent oral and written communication skills.
• Detail-oriented with strong follow-through.

Responsibilities

• Promptly identify and resolve errors or issues related to precertification and test/surgery scheduling.
• Communicate with insurance payer representatives, patients, and employees to ensure timely and accurate scheduling for surgeries and procedures (including Commercial plans, Medicare/Medicare HMO, Medicaid/Medicaid HMO, BCBSTN, etc.).
• Operate within established guidelines and protocols, including submitting required documentation (office notes, test reports, etc.) to insurance carriers.
• Obtain pre-certification/pre-authorization from insurance companies prior to tests or procedures.
• Manage patient insurance verification using insurance websites, phone, fax, and other available methods.
• Perform timely follow-up on all submitted verifications and pre-certifications.
• Notify physicians promptly regarding denials, approvals, or related updates.
• Communicate effectively and professionally with patients, physicians, and staff.
• Escort patients from the waiting room to exam rooms in a courteous manner.
• Collect and record patient medical histories, vital signs, medication information, and allergies in the electronic health record (EHR).
• Assist providers during patient examinations and procedures, including cast, splint, suture, and dressing removal, as well as injections and aspirations.
• Update patient charts during visits, accurately documenting histories, physical exams, treatment plans, and provider notes using medical terminology and abbreviations.
• Enter E&M/CPT codes and submit charges to the coding department.
• Provide clear care plan instructions and patient education, including reviewing home exercise programs.
• Review charts for completeness and accuracy.
• Clean and sanitize exam rooms between patients to maintain a safe and welcoming environment.

Benefits

• Competitive pay.
• Comprehensive benefits package, including medical, dental, vision, 401(k) with employer match, and discretionary profit-sharing.
• Paid Time Off (increasing with years of service).
• Paid Holidays.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed