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

Northeast Georgia Medical Center•Dacula, GA

About The Position

The Precert Specialist is responsible for obtaining pre-certifications and referrals from insurance plans for services provided to NGPG patients, verifying insurance benefits and eligibility, and resolving pre-certification, registration, and case-related issues. The role answers and triages telephone and electronic referral requests, directs patients to appropriate specialty physicians based on their symptoms, and maintains current knowledge of NGPG practices, providers, and services. The specialist documents referrals, communications, actions, and other information in multiple systems; generates and distributes applicable forms and paperwork; and supports patient satisfaction through responsive, professional service.

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 while working at a rapid pace with frequent 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.
Strong interpersonal and telephone customer-service skills.
Working knowledge of Protected Health Information.
Initiative and ability 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 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.

Responsibilities

Obtain pre-certifications and referrals from insurance plans for NGPG patient services and follow up to confirm approval.
Verify insurance benefits, eligibility, and coverage guidelines; identify managed care contracts and referral patterns.
Assist with insurance claims and help patients complete forms required for pre-certification.
Maintain pre-certifications for in-office and out-of-office procedures, including imaging services such as MRI, MRA, CT, and PET.
Follow up with other physician offices to ensure referrals are obtained for office visits.
Answer telephone calls and electronic referral requests promptly; triage requests and schedule patients with appropriate specialty physicians based on symptoms.
Answer routine patient questions and coordinate calls with the appropriate provider or personnel when needed.
Maintain current knowledge of NGPG practices, providers, and services.
Support patient satisfaction by ensuring patients' needs are met and questions are answered.
Build relationships with physicians and office staff to improve referral accuracy, customer care, and referral-process practices.
Maintain and update the NGPG Referral SharePoint database with current physician information.
Enter patient insurance and personal information into systems, maintain records, and provide referral reports to administration.
Process benefit correspondence and document referrals, communications, actions, and other data in information systems.
Follow confidentiality requirements and HIPAA, DNV, OSHA, and other health regulations.
Contribute positively to the care team as circumstances or the work environment change; cross-train as requested and perform other related duties as assigned.