Referral & Pre-Cert Technician

Job Description

SUMMARY:

Under general supervision, the Referral & Pre-Certification Coordinator is responsible for coordinating the inpatient and outpatient care and treatment of patients through the process of scheduling referrals & pre-certifications

ESSENTIAL DUTIES AND RESPONSIBILITIES:

*Include the following. Other duties may be assigned.*

• Obtain insurance referrals for patient care.
• Schedule patients for hospital surgeries and diagnostic procedures.
• Give instructions and/or explain procedures to patients as directed by physician.
• Pre-certify patients for surgeries and/or hospital stays.
• Verify insurance coverage and referral needs.
• Schedule and refer patients to secondary specialists.
• Obtain and submit necessary information, files, and reports to appropriate personnel.
• Referral follow up, make sure provider receives records from specialists.
• Assist in arranging infusions.
• Obtain authorizations for medications.
• Abide by the rules and regulations as set forth by the State of Tennessee.

EDUCATION AND/OR EXPERIENCE:

Graduation from a standard high school or General Education Degree (GED) equivalent. Successful completion of a patient care course such as CMA or CNA program is a plus.   Two or three years related experience and/or training in a medical office with a background knowledge of insurance; or equivalent combination of education and experience.  Knowledge of ICD-10 and CPT coding needed.

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EOE/AA/M/F/Disability/Vet

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