Precertification/Referral Specialist

Posted On: 06/24/2020

Full-Time, Monday-Friday

Crestview Location

Summary:

Under the direction of the Director of Operations and Provider Relations, the Precertification/Referral Specialist confirms insurance eligibility with the payor as necessary for referrals, co-pay determination, pre-approval for procedures, and patient deductible determination.  The incumbent is also responsible for determining the need for additional information from referral sources and shall facilitate obtaining all appropriate information necessary to process the referral.  They will interact with patients regarding billing, payment and resolution.

Requirements:

  • High School Diploma or GED
  • 1-3 years of customer service experience in a call center environment, preferably in healthcare.
  • Excellent interpersonal and communication skills with nursing staff, physicians, nurse practitioners, and other health workers involved in patient care.
  • Ability to work in a dynamic, fast-paced team environment and to promote team concepts.
  • Knowledge of Microsoft Office including Outlook, PowerPoint, Excel, and Word.
  • Preferred: Knowledge of medical terminology, CPT and ICD-9 coding.
  • Ability to work with limited supervision.
  • Good organization skills and attention to detail.
  • Ability to multitask well and prioritize.

Physical Requirements:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job.

The employee is regularly required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and talk or hear.  The employee is occasionally required to stoop, kneel, crouch, or crawl.

The employee must occasionally lift and/or move up to 25 pounds.  Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.