Referral Specialist - Rheumatology * Days - 40hrs/wk.
Requisition #: req1720
FTE status: 1
To manage the flow of information related to referrals. This will include, but not limited to, documentation, tracking, pre-authorizations, certifications and follow-ups, related to all insurance type referrals. This person works closely with physicians, nursing staff and other clerical staff.
Essential Functions and Responsibilities:
- Minimum 2 years experience or training in medical office or similar setting and/or prior referral experience.
- High School education or equivalent
- Medical terminology required
- Able to work independently and collaboratively with minimal supervision
- Possess knowledge of medical records content and sequence
- Training or experiences in ICD-9 CM coding and managed care insurance plans
- Possess knowledge of appointment scheduling process
- Must process work with minimal errors within appropriate deadlines and timeframes
- Possess a high level of interpersonal skills
- Communicate effectively, both verbal and written
- Able to prioritize, maintain accurate records, and work under deadline situations
- Demonstrates a professional manner when representing BHC
- Excellent customer service skills
- Schedules and coordinates specialist appointments, procedures and tests done internally or externally.
- Provide accurate documentation and record keeping on referrals, authorizations, and boardings.
- Relay and/or review referral information in a timely fashion with appropriate clinical areas, physicians, physician office and patients.
- Monitor guidelines for authorizations and referrals according to payer requirements.
- Monitor “in network” referrals.
- Ensures proper insurance authorizations are processed within 48 hours.
- Ensure the physician provides necessary medical and patient information to referral specialist prior to patient referral.
- Monitor EPIC orders to ensure provider has entered information correctly.
- Work closely with central scheduling, pre-reg and O/P for coordination of services.
- Communicate and collaborate with other members of the health care team to ensure continuity and coordination of services.
- Interacts with providers when determining referral alternatives.
- Provides ICD-9 CPT coding on referrals, as needed.
- Provides information to internal and external customers promoting good public relations and interdepartmental relations.
- Demonstrate a willingness to promptly meet identified needs in a pleasant and courteous manner.
- Educate physician and staff, when necessary.
- Identify and address referral issues as they arise.
- Manage incoming phone calls, performs associated functions and follow up.
- Answer telephone in a timely manner.
- Maintain appropriate notes for referrals, phone calls and documents in EPIC.
- Respond to messages left on referral queue line.
- Use good telephone etiquette when answering phones, identifying self by name, title, and area.
- Participate and work effectively as a team member ensuring continuity and coordination of services.
- Attend and participate in all mandatory meetings, in-services, and staff meetings.
- Complete required Corporate Compliance / HIPAA education.
- Is knowledgeable with hospital and departmental policies/procedures and participate in revising as requested.
- Make suggestions and recommendations for improvement of the referral process.
- Provide assistance, as needed, and performs other duties as required.
- Attends meeting as requested to assist with the referral process.
- Collaborate, communicate, and support team building.
- Assist areas within MHB office to maintain collaboration and team support.
- Work with billing office on denials.
- Maintains a clean, safe and functional working environment.
- Maintain an organized work area.
- Takes initiative to notify appropriate person of environmental safety issues/or repairs.
- Performs other duties as directed by Manager or Director of Medical Education
- Accept responsibilities willingly.
- Complete tasks within timeframes requested.
- Act as superuser for EPIC
- Customer Service
- Communicates effectively and positively.
- Maintains confidentiality/privacy at all times and HIPAA guidelines.
- Verbal and non-verbal communication demonstrates empathy and concern at all times.
- Is a role model for other team members.
- Treat others with dignity and respect.
- Maintain good public relations.