Precert & Referral Coordinator

Northeast Georgia Health System; Dacula (GA); On-site; USD 38,000 - 60,000; Full time

Job summary

Northeast Georgia Health System is seeking a Referral Specialist to answer and triage referral-related calls, verify insurance eligibility, and obtain pre-certifications for NGPG services. The role requires maintaining knowledge of NGPG practices and coordinating with physicians and patients.

Excellent communication, problem solving, and customer service skills are essential in this fast-paced role focused on accurate referrals and HIPAA compliance.

Qualifications

• High School Diploma.
• Minimum one year customer service experience relating to the medical profession.
• Knowledge of medical terminology.
• CMA is preferred.

Responsibilities

• Answer and triage telephone calls related to referral requests to the appropriate physician.
• Maintain current knowledge of NGPG practices, physicians and services.
• Obtain pre-certification/referrals from all insurance plans for services provided to NGPG patients.
• Verify insurance benefits and eligibility.
• Document referrals, communications, actions, and other data in an information system.
• Generate and distribute applicable forms, notifications, and paperwork.
• Follow-up with insurance companies to ensure pre-certification is approved.
• Follow-up with other doctors offices to ensure referral has been obtained for office visit.
• Maintain knowledge of procedures and HIPAA and health regulations.

Skills

Customer service

Medical terminology

Communication

Problem solving

Interpersonal skills

HIPAA knowledge

Education

High School Diploma

CMA

Job description

Northeast Georgia Health System is seeking a Referral Specialist to answer and triage referral-related calls, verify insurance eligibility, and obtain pre-certifications for NGPG services. The role requires maintaining knowledge of NGPG practices and coordinating with physicians and patients.

Excellent communication, problem solving, and customer service skills are essential in this fast-paced role focused on accurate referrals and HIPAA compliance.