Referral Specialist- Curry Medical North

16 hours ago

Gold Beach, United States Curry Health Network Full time
JOB SUMMARY

Under general supervision from the Population Health Manager, the Referral Specialist’s primary function is the coordination, processing and scheduling of medical referrals and prior authorizations for a variety of medical services/procedures for patients as requested by medical providers. Referral and Authorization Specialist will collaborate with other referral staff, medical providers, nursing staff and other patient care support staff.

ESSENTIAL FUNCTIONS

Responsible for obtaining managed care authorizations and verifying patient insurance benefits. Prepare reports and statistical data when requested.

Gathers pertinent information as needed via EHR or from clinical team to accurately complete referral and authorization process. Review details and expectations about the referral and authorization with patients.

Monitors electronic health record (EHR) notifications throughout the day to capture referral and authorization requests in real time.

Respond to In-house provider questions, requests and concerns regarding the status of patient referrals or authorization, care coordination or follow-up status.

Fax referral form to providers that do not require any records to be sent. For primary patient visits, fax referral form and print requested records that are obtained.

When claims are denied, the referral and authorization specialist is responsible for reviewing the claim details and pursuing action as warranted.

Other duties as assigned to support the overall effectiveness of the department and organizational performance in accordance with Curry Health Network’s Mission, Vision and Shared Values.

SHARED VALUES

Accountability – we will take personal ownership of our actions. We follow safety policies and employ safe practices. We identify and report safety hazards promptly, work together to isolate risks and apply remedies as needed.

Compassion – we will be empathetic, respectful, courteous, and kind in our relationships with our patients and each other.

Excellence – we will distinguish ourselves by continuing to improve quality in all that we do. We display attitudes and mannerisms which demonstrate to our community that we are sensitive to their physical, emotional, and spiritual wellbeing. We strive to become the best we can be in our roles.

Integrity – we will be honest and act in the best interest of our patients and community.

Stewardship – we will use our resources for the highest and best purposes of the community.

Teamwork – we will be united in our efforts to achieve our goal of quality patient care, seeking opportunities to assist each other, and appreciating equally the contributions of all.

MINIMUM JOB REQUIREMENTS

Education & Experience

  • A High School diploma or equivalent is required.
  • Two years’ experience in a clinic setting preferred.
Required Knowledge, Skills & Abilities
  • Able to treat patients, providers and co-workers with dignity & respect at all times.
  • Knowledge of the medical clinic purpose and operations.
  • Ability to prioritize duties, perform them efficiently and adjust to and accept the unexpected.
  • Excellent written and verbal communication skills, telephone manners and proper telephone etiquette are required
  • Knowledge of medical terminology; knowledge of various insurance plans such as Medicaid, Medicare and private insurances.
  • Skills in using medical databases; CPSI-EHR systems.
  • Proficient using computer software incl. Microsoft Office: Word, Excel, Outlook.


PHYSICAL REQUIREMENTS

Physical Demands

On-the-job time is spent in the following physical activities:

None of the time: Taste or Smell, Use hands, Push, Pull, Stoop, kneel, crouch or crawl

Up to 1/3 of the time: Stand, Walk

From 1/3 to 1/2 of the time: No requirement

Up 2/3 of the time and more: Sit, talk or hear

This job requires that weight be lifted, or force be exerted as follows:

None of the time: Up to or more than 50 pounds

Up to 1/3 of the time: Up to 25 pounds

From 1/3 to 1/2 of the time: No requirement

Up to 2/3 of the time and more: No Requirement

This job has special vision requirements as follows:

Close, distance, color, peripheral, depth perception and the ability to adjust focus.

Work Environment

This job requires exposure to the following environmental conditions:

None of the time: We, humid conditions, Work near moving mechanical parts, Fumes or airborne particles, Toxic or caustic chemicals, Outdoor weather conditions, Extreme cold, Extreme heat, Risk of Electrical shock, work with explosives, risk of radiation, vibration

Up to 1/3 of the time: No requirement

From 1/3 to 1/2 of the time: No requirement

The typical noise level for the work environment is: quiet to moderate noise.

Hearing requirements: ability to hear instructions, ability to hear patient

This job requires the following repetitive motion actions:

0 hours: Repetitive use of foot control

From 1 – 2 hours per day: Grasping firm/heavy

From 3-4 hours per day: No requirement

From 5-6 hours per day: No Requirement

From 7+ hours per day: Repetitive use of hands, Fine dexterity, Grasping simple/light

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

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