Precertification & Referral Specialist

Essential Duties

The following list describes the essential duties of this role. Individuals in this role may not perform all these duties or may perform additional or unrelated duties.

  • Verify patient eligibility and review benefits.
  • Review codes and submit prior authorization request.
  • Review and submit clinicals documentations.
  • Follow through with obtaining the prior authorization.
  • Coordinate Peer-to-Peer review when needed.
  • Submit Appeals.
  • Collect pre-payments when applicable.
  • Submit retro-authorizations when applicable.
  • Meets department production standards consistently as defined by the department management.
  • File completed requests as per established procedures.
  • Continually monitor schedule to ascertain most current data.
  • Document all pertinent information and communications in medical systems.
  • Perform all duties respectful of confidentiality and safety of all patients, employees, and providers.
  • Requires working knowledge of HIPAA Privacy Rules compliance.

Job Requirements

  • Education: High School Diploma or equivalent.
  • Experience: 2 years medical experience required. Medical billing/coding knowledge required.
  • Skills: Ability to prioritize and handle multiple tasks in a changing work environment. Excellent written and verbal communication skills. Ability to work independently and in a team. Ability to interpret an approval or denial letter and take additional and necessary steps towards approval for services. Strong attention to detail.

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