Precertification Specialist - Longstreet Clinic - Obgyn

Job Category:

Administrative & Clerical

Work Shift/Schedule:

8 Hr Evening - Morning

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

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.

Minimum Job Qualifications

• Licensure or other certifications:

• Educational Requirements: High School Diploma or GED.

• Minimum Experience:

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications: Medical Office Assistant certificate.

• Preferred Educational Requirements:

• Preferred Experience: Minimum of one (1) year in medical office or hospital setting with experience in pre-certification or referral.

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• 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

Essential Tasks and 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.

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

• Vision: Occasionally 0-30% of time

• Kneeling/Stooping/Bending: Occasionally 0-30%

• Standing/Walking: Occasionally 0-30%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Occasionally 0-30%

• Job Requires: Reading, Writing, Reasoning, Talking

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.