Referral & Pre-Certification Specialist

Northeast Georgia Medical Center; Dacula (GA); On-site; USD 21,000 - 30,000; Full time

Job summary

Northeast Georgia Health System in Georgia is seeking a Referral Specialist to triage calls and coordinate referrals to the appropriate physician. You will verify insurance benefits and eligibility, obtain pre-certifications, and document all interactions in our information system.

The role emphasizes strong communication, attention to detail, and the ability to work with patients, physicians, and office staff to ensure timely referrals and accurate patient information.

Qualifications

• High School Diploma is required.
• Minimum one year customer service experience in the medical field.
• Knowledge of medical terminology.

Responsibilities

• Obtain pre-certification/referrals from all insurance plans for NGPG services and verify benefits/eligibility.
• Assist patients in completing forms for pre-certification; maintain pre-certifications for in-office and out-of-office procedures.
• Follow-up with insurance companies to ensure pre-certification is approved.
• Follow-up with other doctors' offices to ensure referrals have been obtained for visits.
• Maintain confidentiality and comply with HIPAA and health regulations.
• Answer routine questions from patients and coordinate calls to providers as needed.
• Maintain NGPG Referral SharePoint site and update physician information.
• Enter patient insurance and personal information in the system and provide referral reports.

Skills

Customer service

Medical terminology

Communication

Interpersonal skills

Phone etiquette

Education

High School Diploma

CMA

Job description

Northeast Georgia Health System in Georgia is seeking a Referral Specialist to triage calls and coordinate referrals to the appropriate physician. You will verify insurance benefits and eligibility, obtain pre-certifications, and document all interactions in our information system.

The role emphasizes strong communication, attention to detail, and the ability to work with patients, physicians, and office staff to ensure timely referrals and accurate patient information.