Provides direct customer service for assigned departments to include but not limited to referrals, scheduling, verifying insurance, obtaining and processing patient data, and obtaining pre-certification for necessary referrals/procedures that require prior authorization. Handles customer account transactions, provides customer assistance, and interfaces with multiple clinics. Adheres to policies, procedures and regulations to ensure compliance and patient safety. Participation in Compliance and other important training is a condition of employment.
Provides direct customer service for assigned departments to include but not limited to obtaining referrals, working referral worklists, scheduling and verifying insurance. Performs electronic eligibility verification, updating patient demographics, ensure required referrals and prior authorization are in place for patient visit. Answer questions from patients regarding the status of their referral. Mail fax, or communicate appropriate records, certification and authorizations to appropriate persons for the completion of the referral process. Review and explain process for referrals to patient including, but not limited to what is involved, who the provider is, and the location of the specialist office. Maintain up-to date knowledge of referral guidelines, active providers, and necessary coverage information. Responsible for obtaining “expert” level knowledge of the inter-workings of various insurance plans. Responds effectively to incoming patient calls and communicates pertinent information to physician or designee to provide for continuity and optimal care. Attends departmental meetings and provides constructive recommendations for areas of improvement. Appropriately communicates physician orders and instructions to patients. Documents pertinent patient information in the electronic medical record as it relates to job function. Reviewing and routing electronic documents requiring clinical action to appropriate parties. Research and complete required documents/medical charts requiring additional actions. Coordinates with various Specialty Provider Clinics and ancillary clinical areas regarding any scheduling and referral guidelines, including pre-testing or documents needed prior to appointments. Meets established productivity, schedule adherence, and quality standards. Other duties as assigned.
Required: High School Diploma or GED equivalent.
Required: One (1) year of previously related experience.
Excellent communication, organization and customer service skills. Knowledge of medical terminology and CPT/ICD-9 coding. Self-motivated, strong computer skills.. Proven ability to problem-solve. Strong attention to detail. Ability to manage time effectively and work independently. Bilingual preferred.