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Precertification Jobs in Tennessee (NOW HIRING)

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Precertification information

What is a precertification specialist?

Precertification jobs involve reviewing and approving medical procedures, treatments, or hospital admissions before they occur to ensure they meet insurance or regulatory requirements. Professionals in these roles typically evaluate patient information, communicate with healthcare providers, and coordinate with insurance companies to determine if services will be covered. This process helps control healthcare costs and ensures that patients receive appropriate care according to established guidelines. Precertification specialists often work in hospitals, insurance companies, or healthcare administration settings.

What are common challenges faced by precertification specialists, and how can they be addressed?

Precertification Specialists often face challenges such as staying up-to-date with constantly changing insurance guidelines, managing high volumes of requests, and communicating effectively with both healthcare providers and insurance representatives. To address these, it is important to maintain strong organizational skills, leverage available technology for tracking authorizations, and participate in ongoing training to remain current on payer requirements. Building good relationships with team members and regularly sharing updates can also help streamline processes and minimize delays.

What skills and qualifications are needed to thrive as a precertification specialist?

Success as a precertification specialist requires knowledge of medical terminology, insurance verification, and healthcare regulations, often supported by a background in healthcare administration or certification such as Certified Medical Administrative Assistant (CMAA). Familiarity with insurance portals, electronic health record (EHR) systems, and payer-specific software is typically necessary. Attention to detail, strong organizational skills, and effective communication are vital soft skills that help in coordinating between providers, patients, and insurers. These abilities ensure accurate and timely approval of medical procedures, reducing delays in patient care and minimizing claim denials.

What is the difference between Precertification vs Medical Coder?

AspectPrecertificationMedical Coder
Required credentialsCertification may be preferred; knowledge of insurance policiesCertification (e.g., CPC, CCS) often required
Work environmentHealthcare facilities, insurance companies, outpatient clinicsHospitals, clinics, insurance companies, remote work
Employer usageUsed to approve procedures before serviceUsed to assign codes for billing and documentation
Common search intentPrecertification vs Medical Coder

Precertification involves obtaining approval from insurance companies before procedures, focusing on insurance policies and patient eligibility. Medical coders assign standardized codes to medical records for billing, emphasizing coding accuracy and documentation. While both roles are integral to healthcare billing, precertification is about approval processes, whereas medical coding centers on documentation and coding accuracy.

What are the most commonly searched types of Precertification jobs in Tennessee? The most popular types of Precertification jobs in Tennessee are:
What are popular job titles related to Precertification jobs in Tennessee? For Precertification jobs in Tennessee, the most frequently searched job titles are:
What job categories do people searching Precertification jobs in Tennessee look for? The top searched job categories for Precertification jobs in Tennessee are:
Precertification jobs near you
Infographic showing various Precertification job openings in Tennessee as of August 2026, with employment types broken down into 3% As Needed, 83% Full Time, 13% Part Time, and 1% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution.

PreCertification Coordinator

Tennessee Orthopaedic Alliance

Columbia, TN • On-site

Other

Medical, Dental, Vision, Retirement, PTO

Posted 18 days ago

Tennessee Orthopaedic Alliance rating

7.1

Company rating: 7.1 out of 10

Based on 19 frontline employees who took The Breakroom Quiz

Job description

This position is a full-time, permanent onsite non-clinical position within Tennessee Orthopaedic Alliance in Columbia, TN.
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.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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