Precert Specialist - Northeast Georgia Physicians Group NGPG - Family Medicine - FT Days

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Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

The Referral Specialist will be responsible for answering and triaging telephone calls related to referral requests to the appropriate physician.  In addition, this position will be responsible for maintaining current knowledge of NGPG practices, physicians and services.  Responsible for obtaining pre-certification/referrals from all insurance plans for services provided to NGPG patients as it relates to authorization requests and reimbursements. Verifies insurance benefits and eligibility.  Resolves pre-certification, registration, and case-related issues. Documents referrals, communications, actions, and other data in an information system. Generates and distributes all applicable forms, notifications, and paperwork.

Minimum Job Qualifications

• Licensure or other certifications:

• Educational Requirements: High School Diploma.

• Minimum Experience: Minimum one year customer service experience relating to the medical profession. Knowledge of medical terminology.

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications: CMA.

• Preferred Educational Requirements:

• Preferred Experience: Physician practice and/or call center experience or one year in medical office or hospital setting with experience in pre-certification or referral preferred. Bilingual (English/Spanish) speaking skills preferred, but not required.

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Must demonstrate ability to prioritize assignments and organize

• Ability to work at a rapid pace with numerous interruptions with ability to prioritize.

• Demonstrates tact to deal effectively with patients, physicians, and other employees of the practice. 

• Proven skills in communication, problem solving, interpersonal relationships, and must be detail oriented.

• Professional customer service attitude, ability to communicate with and assess customer needs.

• Exceptional interpersonal and telephone customer service skills.

• Working knowledge of Protected Health Information.

• Initiative & drive to take a project from its inception to a successful conclusion. 

Essential Tasks and Responsibilities

• Responsible for obtaining pre-certification / referrals from all insurance plans for services provided to NGPG patients as it relates to reimbursement. Verify insurance benefits and eligibility. Identify managed care contracts and referral patterns. Assist in processing insurance claims. 

• Assist patients in completing necessary forms to obtain pre-certification from insurance companies. Maintain pre-certs for in office procedures and out of office procedures such as (but not limited to) MRI, MRA, CT, PET, etc. Follow-up with insurance companies ensuring that pre-certification is approved. 

• Follow-up with other doctors offices to ensure referral has been obtained for office visit. 

• Ensures confidentiality and follows HIPAA, DNV, OSHA and other Health Regulations.

• Promptly answers telephone calls and responds to electronic referral requests.

• Triages all referral requests (calls & electronic) and schedules with the appropriate specialty physicians based patients symptoms.

• Responsible for answering routine questions from patients and coordinating calls to appropriate provider or personnel if needed.

• Responsible for maintaining current knowledge of NGPG practices, providers and services offered.  

• Assists with patient satisfaction by ensuring that patient's needs are being met and their questions are answered.

• Cultivates strong relationships with physicians and office staff to increase accurate patient referrals, provide exceptional customer care to patients, identify issues and concerns in the referral process to determine best practices.

• Responsible for the NGPG Referral SharePoint site: Maintains and updates database with current physician information.

• Ability to navigate multiple systems at the same time.  

• Responsible for entering patient insurance and personal information in system. Maintains records and provides referral reports to administration. 

• Verifies insurance eligibility and coverage guidelines as well as process benefit correspondence in the system. 

• Contributes to the care team effort by responding positively to changing circumstances and/or environment.

• Performs other related job duties or functions as requested or assigned. Cross trains as requested. 

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

• Weight Carried: Up to 2 lbs, Occasionally 0-30% of time

• Vision: Moderate, Frequently 31-65% of time

• Kneeling/Stooping/Bending: Occasionally 0-30%

• Standing/Walking: Occasionally 0-30%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Occasionally 0-30%

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. 

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.