Medical Assistant and Precertification Specialist

Responsibilities

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.

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.

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.