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Pre Certification Jobs in Tennessee (NOW HIRING)

Covenant Health

REFERRAL & PRECERT SPEC

Knoxville, TN · On-site

Obtains any necessary referrals or pre-certifications. Responsibilities * Schedules inpatient/outpatient tests, procedures and appointments as directed by provider. Documents each scheduled event in ...

Covenant Health

REFERRAL & PRECERT SPEC

Oak Ridge, TN · On-site

Obtains any necessary referrals or pre-certifications. Responsibilities * Schedules inpatient/outpatient tests, procedures and appointments as directed by provider. Documents each scheduled event in ...

Covenant Health

REFERRAL & PRECERT SPEC

Oak Ridge, TN · On-site

Obtains any necessary referrals or pre-certifications. * Schedules inpatient/outpatient tests, procedures and appointments as directed by provider. Documents each scheduled event in detail in the ...

Covenant Health

PATIENT REGISTRATION SPEC

Tazewell, TN

$13 - $17.75/hr

Ensures verification of benefits and pre-certification requirements are met prior to scheduled appointment/admission. Follows up as necessary on all urgent or unscheduled registrations for ...

Covenant Health

PATIENT REGISTRATION SPEC

Tazewell, TN · On-site

$13 - $17.75/hr

Ensures verification of benefits and pre-certification requirements are met prior to scheduled appointment/admission. Follows up as necessary on all urgent or unscheduled registrations for ...

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Pre Certification information

What is a pre certification specialist?

A Pre Certification specialist is a healthcare professional responsible for obtaining approval from insurance companies before certain medical procedures, treatments, or hospital admissions. Their job involves verifying patient insurance coverage, submitting necessary documentation, and communicating with both healthcare providers and insurers to ensure services are authorized. This process helps prevent unexpected costs for patients and ensures compliance with insurance requirements. Pre Certification specialists play a crucial role in streamlining patient care and reducing claim denials.

What are some common challenges faced in a pre certification role and how can they be managed effectively?

Professionals in Pre Certification often encounter challenges such as navigating complex insurance requirements, managing high volumes of authorization requests, and staying up-to-date with frequent policy changes. Effective communication with healthcare providers and insurance companies is essential to ensure timely approvals and minimize delays in patient care. Developing strong organizational skills, leveraging electronic health record (EHR) systems, and participating in regular training can help manage these challenges and improve workflow efficiency.

What are the key skills and qualifications needed to thrive as a pre certification specialist, and why are they important?

To thrive as a Pre-Certification Specialist, you need a solid understanding of medical terminology, insurance policies, and healthcare procedures, often supported by a background in healthcare administration or medical billing. Familiarity with pre-authorization systems, electronic health records (EHRs), and payer portals is typically required. Excellent attention to detail, organizational skills, and effective communication are crucial soft skills for this role. These competencies are essential to ensure accurate, timely insurance approvals and to facilitate uninterrupted patient care and reimbursement.

What is the difference between Pre Certification vs Certified Technician?

AspectPre CertificationCertified Technician
Required CredentialsTypically no formal certification required, often an entry-level or preparatory statusRequires specific certifications or licenses, demonstrating proficiency
Work EnvironmentTraining settings, entry-level roles, or preparatory stagesActive work in the field, performing technical tasks
Employer UsageUsed to indicate readiness for certification or entry-level statusIndicates a qualified professional with verified skills

Pre Certification generally refers to an initial or preparatory status before obtaining full certification. Certified Technician signifies a professional who has met certification requirements and is qualified to perform technical tasks independently. The main difference lies in certification status and work readiness, with Pre Certification serving as a stepping stone towards full certification.

What are the most commonly searched types of Pre Certification jobs in Tennessee?

The most popular types of Pre Certification jobs in Tennessee are:

What are popular job titles related to Pre Certification jobs in Tennessee?

For Pre Certification jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Pre Certification jobs in Tennessee look for?

The top searched job categories for Pre Certification jobs in Tennessee are:

What cities in Tennessee are hiring for Pre Certification jobs?

Cities in Tennessee with the most Pre Certification job openings:

Pre Certification jobs near you
Infographic showing various Pre Certification job openings in Tennessee as of August 2026, with employment types broken down into 2% As Needed, 78% Full Time, 14% Part Time, and 6% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution.

Specialist-Authorization Denial

Mississippi Baptist Health Systems

Memphis, TN • On-site

$16 - $21.50/hr

Other

Re-posted 27 days ago

Job description

Authorization Denial Specialist

Authorization Denial Specialist ensures that chemotherapy (specialty group) and other infusions/radiation therapy/radiology/surgical services meet medical necessity and appropriateness per insurance medical policies/FDA/NCCN guidelines. Initiates and coordinates pre-certifications/prior authorizations per payer guidelines prior to services being rendered and completes the Insurance verification process.

Reviews clinical information and supporting documentation for outpatient or Part B services authorization denials to determine and perform retro authorizations, reconsiderations or appeal actions to defend the revenue. Performs other duties as assigned.

• Obtain and review treatment/therapy plan orders for medical necessity and appropriateness according to insurance medical policy/FDA/NCCN guidelines and requirements.

• Research insurance company medical policies, medical literature, and compendiums to determine eligibility for services. Utilize multiple healthcare websites.

• Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner.

• Responsible for completing the Insurance Verification process.

• Works closely with physicians and clinic staff obtain authorizations to promote positive patient outcomes, timely treatment and positive reimbursement.

• Understands and complies with regulatory requirements by specific insurance companies and facilitates compliance by maintaining awareness of guidelines and ensuring compliance through communication and documentation to appropriate staff.

• Reviews, assesses and evaluates all authorization denial communications received in order to optimize reimbursement.

Minimum Required: 3 – 5 years of business experience in a healthcare environment with 2 of those years being in a clinical setting.

Preferred/Desired: 5 years of business experience in a healthcare environment with at least 3 years payer specific experience. 3 years clinical experience in a clinical care setting. Pre-certification experience desired.

Minimum Required: Skill in communicating clearly and effectively using standard English in written, oral, and verbal format to achieve high productivity and efficiency. Skill to write legibly and record information accurately as necessary to perform job duties. Strong organizational skills. Ability to type and/or key correctly.

Preferred/Desired: Associates degree or 2 years of college level courses.

Minimum Required: Requires critical thinking and judgement.

Preferred/Desired: Must demonstrate the ability to appropriately use standard criteria established by payers. Special Skills Excellent customer service and communication skills. Ability to speak, articulate, and be understood clearly.

Minimum Required: Ability to read and understand medical policies, compendiums, LCDs, and FDA guidelines. Must be able to multi-task and be flexible. Advance computer literacy skills and problem-solving skills. Ability to deal with confrontational issues and high stress situations with patients, family, and physicians.

Preferred/Desired: Knowledge of oncology pre-certification requirements and guidelines. Licensure: Pharmacy Tech, CHAA, RHIT, LPN, RN

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