Full employer posting
JOB TITLE: Pre-Certification Specialist DEPT: Financial Counseling LOCATION: Maury Regional Medical Center Plaza - Columbia, TN
PRN, Thu-Mon 9a-3:30p MAURY REGIONAL HEALTH: At Maury Regional Health, patients are at the heart of everything we do. We're committed to clinical excellence and compassionate care, offering exceptional service. As a top-rated organization, we foster an inclusive, collaborative work environment where innovation and patient care lead the way.
The Pre-Service Representative is responsible for coordinating patient scheduling, insurance verification, pre-certification, pre-authorization, and medical necessity requirements before scheduled healthcare services. This position reviews physician orders and clinical documentation for accuracy and completeness while ensuring payer requirements are met within established timeframes. The representative provides knowledgeable and professional support to patients, providers, and hospital departments while using critical thinking and sound judgment in a fast-paced healthcare environment.
DUTIES: Reviews physician orders and scheduled procedures for accuracy and completeness, including patient status, CPT codes, ICD-10 codes, and required supporting documentation. Verifies patient demographic information and insurance coverage using electronic verification systems, payer websites, and direct communication with insurance carriers. Obtains required pre-certifications, pre-authorizations, and insurance determinations within established payer and departmental timeframes prior to the date of service.
Validates authorization determinations and completes medical necessity, pre-determination, and other payer-specific requirements as applicable. Accurately documents authorization details and other critical information in appropriate systems to support established workflows and timely claims processing. Communicates effectively with patients, physician offices, insurance carriers, and hospital departments to resolve authorization issues, denials, procedure changes, or other barriers to scheduled services.
Organizes and prioritizes daily work assignments to meet productivity, accuracy, and timeliness expectations while providing a positive patient experience. Supports staff development and operational excellence by mentoring team members, identifying opportunities for improvement, assisting with denial research and follow-up, and participating in continuous process improvement initiatives. JOB
- 3 Years of Related Healthcare Experience Required
- Associate's Degree Preferred WHY MAURY:
- Medical, Dental, Vision, Retirement Plans & PTO
- Educational Assistance, Tuition Reimbursement & Career Advancement Navigation
- Employee Discounts
- Childcare Services
- Adoption Assistance For more information: About Maury Regional Health MISSION, VISION & VALUES: MISSION: Clinical excellence. Compassionate care. Every patient. Every day. VISION: To be the trusted choice for health and wellness in southern Middle Tennessee by delivering a safe, seamless and patient-centered experience. VALUES: W – Wholeness: Wellness-centered care of mind, body & spirit for our patients & health care team. E – Empathy : Understanding the feelings of others as we walk with them on their path to wellness. C – Community: Creating relationships, connections & trust. A – Advocacy: Defending the rights of all to be heard. R – Respect: Treating everyone with dignity & respect. E – Engagement: Actively involving all stakeholders in creating better health outcomes for southern Middle Tennessee. STRATEGIC ANCHORS:
- Quality patient care
- Highly effective teams
- Stewardship of resources
- Innovative culture Maury Regional Health is committed to the principles of Equal Employment Opportunity in all aspects of the employer/employee relationship. Maury Regional Health grants equal employment opportunities to all qualified persons without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), national origins (including ancestry), genetic information, disability, age, military/national guard/veteran status, sexual orientation, gender identity, or gender expression, or other status protected by state or federal law. Statements made by applicants for employment on this application form will be checked for accuracy. Maury Regional Health campuses are tobacco-free. All tobacco use is prohibited.
About the role
The Pre-Service Representative is responsible for coordinating patient scheduling, insurance verification, pre-certification, pre-authorization, and medical necessity requirements before scheduled healthcare services. This position reviews physician orders and clinical documentation for accuracy and completeness while ensuring payer requirements are met within established timeframes.