Precertification & Referral Specialist

Prisma Health; Columbia (SC); On-site; USD 36,000 - 48,000; Full time

Job summary

Prisma Health in Richland (Ophthalmology 4 Med Park) is seeking an experienced front office professional to streamline referrals and authorizations. You will interface with patients, physician offices, and third-party payors to secure pre-certifications and coordinate scheduling for tests and consultations.

The role emphasizes accurate documentation, timely follow-up, and adherence to HIPAA guidelines while ensuring a positive patient experience in a busy ophthalmology setting.

Qualifications

• High School diploma or equivalent preferred.
• Two years of related work experience.
• Experience in a physician front office, patient registration, and/or electronic scheduling is preferred.

Responsibilities

• Coordinate authorization/precertification with providers, offices, and insurers to obtain prior approvals.
• Document all actions and follow up with patients, referring physicians, and payors.
• Enter and verify demographic, scheduling, and coverage information in the EMR and scheduling systems.

Skills

Customer service

Communication

Interpersonal skills

Insurance knowledge

Medical terminology & CPT coding

Microsoft Office

Education

High School diploma or equivalent

Tools

Microsoft Office

Job description

Prisma Health in Richland (Ophthalmology 4 Med Park) is seeking an experienced front office professional to streamline referrals and authorizations. You will interface with patients, physician offices, and third-party payors to secure pre-certifications and coordinate scheduling for tests and consultations.

The role emphasizes accurate documentation, timely follow-up, and adherence to HIPAA guidelines while ensuring a positive patient experience in a busy ophthalmology setting.