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Referral Specialist Columbiana PC in Columbiana, OH at Mercy Health

Date Posted: 11/8/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    11/8/2018

Job Description

Job Summary

The Referral Authorization Specialist is responsible for overseeing the daily processing of referrals in an efficient manner, facilitating patient information transfer and insurance authorization; Utilizes effective phone and customer service skills; Enters complete and accurate information into appropriate computer system(s) - including but not limited to patient data in registration system, referring physician and patient's primary care provider.

ESSENTIAL FUNCTIONS:

Obtains verification and pre-authorization on assigned diagnostic, surgical and ancillary services.

Receives patient orders and referral faxed from referring physician's office. Communicates with the referring physician's office, other medical offices and/or patient to obtain any records (including radiology films) needed to help the physician make an informed medical decision about the patient's current medical condition. Attaches appropriate patient forms that need to be completed by the physician.

Prioritizes the urgency of patient referrals to make sure patient is seen in a timely fashion.

Communicates with the physician when the new patient cannot be seen within seven days or sooner if specified by the referring physician.

Works collaboratively with all diagnostic and surgical service areas, physician offices and hospitals to ensure timeliness, accuracy and completeness when scheduling patient appointments, tests and procedures.  Consistently and accurately document the date and time of appointment, test, scan or procedure in the patient's medical record. Provides thorough directions to the clinic, verify all paperwork has been received (or instruct patient to arrive early to complete such paperwork.

Notify the appropriate area of the date and time of scheduled appointments, tests and procedures.

Verifying eligibility, documenting physician direct referrals, obtaining pre-certification or authorizations of certain services as defined by the patient’s health insurance plan.

Performs related duties as required.

Qualifications - Minimum

Education:

Required Minimum Education:

High School Diploma or GED

Preferred Education:

2 year Associates Degree

EXPERIENCE:

Minimum of one year of experience as a referral coordinator preferred.

A minimum of one year experience in a healthcare setting, healthcare insurance company, or managed care organization is required.

Knowledge of CPT procedure and ICD-10 coding required; Prior experience with an EMR system preferred; Strong analytical, organizational and time management skills; Ability to multi-task with little supervision; Ability to interact effectively and courteously with members, physicians, providers, payers, and co-workers.

Knowledge of Microsoft Word and Excel; familiar with HIPAA guidelines.

Hours

Hours per pay period: 80

Hours: 8:00am to 4:30pm. 

Shift and Job Schedule

Job Shift: Days, Job Schedule: Full-Time

Equal Employment Opportunity

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