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

Northeast Georgia Health System•Dacula, GA

About The Position

The Precert Specialist (described in the posting as a Referral Specialist) answers and triages telephone and electronic referral requests, directing them to appropriate physicians and scheduling patients with specialty physicians based on their symptoms. The role maintains current knowledge of NGPG practices, physicians, and services and obtains pre-certifications and referrals from insurance plans for services provided to NGPG patients. The specialist verifies insurance benefits, eligibility, and coverage guidelines; resolves pre-certification, registration, and case-related issues; and assists with insurance claims and reimbursement processes. The position also documents referrals, communications, actions, insurance and personal information, and other data in information systems; maintains records and provides referral reports to administration; and generates and distributes applicable forms, notifications, and paperwork. The specialist follows up with insurers and other doctors' offices to confirm authorization and referrals, maintains NGPG's Referral SharePoint site and physician database, and helps ensure patient needs and questions are addressed. The role requires navigating multiple systems and following confidentiality, HIPAA, DNV, OSHA, and other health regulations.

Requirements

High school diploma.
At least one year of customer service experience related to the medical profession.
Knowledge of medical terminology.
Ability to prioritize assignments and organize work, including working rapidly amid numerous interruptions.
Tact and effectiveness in dealing with patients, physicians, and other practice employees.
Communication, problem-solving, and interpersonal skills; attention to detail.
Professional customer-service attitude and ability to communicate with and assess customer needs.
Exceptional interpersonal and telephone customer-service skills.
Working knowledge of Protected Health Information.
Initiative and drive to take a project from inception through successful completion.
Ability to navigate multiple systems at the same time.

Nice To Haves

Certified Medical Assistant (CMA) certification.
Physician practice and/or call center experience, or one year in a medical office or hospital setting with pre-certification or referral experience.
Bilingual English/Spanish speaking skills; preferred but not required.

Responsibilities

Obtain pre-certifications and referrals from insurance plans for services provided to NGPG patients, supporting reimbursement.
Verify insurance benefits, eligibility, and coverage guidelines; identify managed care contracts and referral patterns; and assist with processing insurance claims.
Help patients complete forms needed to obtain insurance pre-certification, and maintain pre-certifications for in-office and out-of-office procedures, including MRI, MRA, CT, and PET procedures.
Follow up with insurance companies to ensure pre-certifications are approved and with other doctors' offices to ensure referrals are obtained for office visits.
Promptly answer telephone calls and electronic referral requests; triage and schedule referral requests with appropriate specialty physicians based on patient symptoms.
Answer routine patient questions and coordinate calls with the appropriate provider or personnel as needed.
Maintain current knowledge of NGPG practices, providers, and services offered.
Support patient satisfaction by ensuring patient needs are met and questions are answered.
Build relationships with physicians and office staff to improve referral accuracy and customer care, and to identify referral-process issues and best practices.
Maintain and update the NGPG Referral SharePoint site and its physician information database.
Enter patient insurance and personal information into systems; maintain records and provide referral reports to administration.
Document referrals, communications, actions, and other data; generate and distribute applicable forms, notifications, and paperwork.
Maintain confidentiality and comply with HIPAA, DNV, OSHA, and other health regulations.
Respond positively to changing circumstances and environments as part of the care team; cross-train when requested and perform other related duties as assigned.