Precertification Specialist - Longstreet Clinic - OBGYN

Northeast Georgia Health System • Gainesville, GA

2d

About The Position

Responsible for obtaining pre-certification/referrals from all insurance plans for services provided to NGHC patients as it relates to reimbursement. Verify insurance benefits and eligibility. Identify managed care contracts and referral patterns.

Requirements

• High School Diploma or GED.
• Demonstrates tact to deal effectively with patients, physicians and other employees of the practice
• Excellent verbal communication skills
• Initiative and drive to take a project from its inception to a successful conclusion
• Ability to maintain strict confidentiality regarding patient information

Nice To Haves

• Medical Office Assistant certificate.
• Minimum of one (1) year in medical office or hospital setting with experience in pre-certification or referral.

Responsibilities

• Responsible for obtaining pre-certification/referrals from all insurance plans for services provided to THC patients as it relates to reimbursement.
• Verify insurance benefits and eligibility.
• Identify managed care contracts and referral patterns.
• Assist in processing insurance claims.
• Answer patient questions and inquiries regarding their accounts.
• Verify insurance eligibility and coverage guidelines as well as process benefit correspondence in system.
• Assist patients in completing necessary forms to obtain pre-certification from insurance companies.
• Maintain pre-certs for in office procedures and out of office procedures such as MRI, MRA, CT, PET and caths.
• Follow up with insurance companies ensuring that pre-certification is approved.
• Follow up with other doctors offices to ensure that referral has been obtained for office visits.
• Assist with maintaining Health Access Referrals (2 per month), assist with maintaining District 2 referrals, assist with maintaining Well Care.
• Assist in maintaining Medicaid REF and PROVIDER ID Tables as well as Referring Doctor Tables.
• Other duties as assigned.
• Add new insurance carriers into system as needed.
• Performs other related job duties or functions as requested or assigned.

What This Job Offers

• Career Level: Entry Level
• Education Level: High school or GED