Precertification/Referral Specialist

Posted On: 07/25/2019


Under the direction of the Director of Operations and Physician Relations, the Precertification/Referral Specialist is responsible for determining the need for additional information from referral sources and shall facilitate obtaining all appropriate information necessary to process the referral.  Interact with patients regarding billing, payment and resolution.  Participates in a team environment to include open communication, trust, accountability and mutual respect

Responsibilities include but are not limited to:

  1. Confirms insurance eligibility with payor as necessary for referrals, co-pay determination, pre-approval for procedures, and patient deductible determination.
  2. Complies with HIPAA regulations at all times.
  3. Obtains precertification from commercial insurance providers as applicable. Responsible for determining the need for additional information from referral sources and shall facilitate obtaining all appropriate information necessary to process the referral.
  4. Interact with patients regarding billing, payment and resolution..
  5. Applies the profession’s code of ethics in all aspects of practice.


  1. High school diploma or
  2. Preferably 1 year of experience in precertification/referral. .
  3. Proficient in MS Office preferably in Excel and Word
  4. Ability to work with limited supervision;
  5. Possess strong verbal communication skills, good organization skills and attention to detail.
  6. Sound judgement and problem-solving skills
  7. Customer-focused attitude, with high level of professionalism and discretion


  1. Skill in exercising a high degree of initiative, judgment, discretion, and decision-making to achieve organizational objectives.
  2. Skill in analyzing situations accurately and taking effective action.
  3. Skill in establishing and maintaining effective working relationships with providers, employees, patients, and the public.
  4. Skill in organizing work, making assignments, and achieving goals and objectives.
  5. Skill in exercising judgment and discretion in developing, applying, interpreting, and coordinating departmental policies and procedures.
  6. Skill in providing excellent customer service and patient services philosophy in all interactions.
  7. Skill in excellent organizational, time management and multi-tasking with attention to detail, as well as stay on task and concentrate with constant interruptions.


  1. Ability to assume responsibility and exercise authority over assigned work functions.
  2. Ability to establish and maintain quality control standards.
  3. Ability to organize and integrate organizational priorities and deadlines.
  4. Ability to investigate and analyze information, draw conclusions and problem solve.
  5. Ability to gather data, compile information, and prepare reports.
  6. Ability to communicate on various levels to include management, customer and associate levels, both orally and in writing
  7. Ability to work and act independently, and to make and carry out decisions with minimal supervision.
  8. Ability to lead teams and projects, and work collaboratively.


Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Work Environment: Position is in a well-lighted office environment. Occasional evening and weekend work.  Short distance travel to other DMA sites with personal vehicle.

Mental/Physical Requirements: Involves sitting, walking, and standing.