Pre Authorization Rep

As a Pre-Authorization Representative, you will be responsible for ensuring a smooth and efficient pre-admission and pre-authorization process for all patients, safeguarding necessary financial clearance before services are rendered.

Every day, you will accurately gather and verify patient demographic and insurance information, obtain necessary pre-certifications and authorizations from insurance companies, and communicate financial responsibilities to patients. You will serve as a key point of contact, coordinating with physicians' offices, insurance providers, and hospital departments to facilitate seamless patient access to care. Your work directly contributes to preventing claim denials and ensuring financial integrity.

To be successful in this role requires meticulous attention to detail, strong knowledge of insurance practices and medical terminology, excellent communication skills, and a commitment to patient advocacy and financial accuracy.

• Responsible for obtaining all pre-authorizations for planned outpatient cardiac imaging ordered by Mountain Management Services providers throughout the practice.
• Interact with coding staff to ensure that medical necessity requirements are met.
• Ensure timely updates of payer coverage.
• Maintain vendor and payer worksheets for all cardiac imaging modalities
• Track and reconcile pre-authorization denials for process improvement
• Notify Manager/Director of documentation improvement opportunities.

Required

• High School Graduate General Studies or High School GED General Studies, upon hire 

Preferred

• Two years’ experience with pre-certifications and/or referrals

CommonSpirit Medical Group (Mountain Management Services) is a leading provider of comprehensive office management services and affiliated physicians in Southeast Tennessee and North Georgia. Our award-winning, faith-based organization is dedicated to supporting the delivery of exceptional healthcare in the region. We are proud to be consistently recognized for excellence by organizations like U.S. News & World Report, PINC AI™, CMS, Healthgrades®, Leapfrog, and as one of the Best Places to Work in Tennessee. We are honored to be your trusted ally in health, dedicated to serving our community with compassion and excellence.

Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit our Total Rewards.

Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.