Patient Referral Specialist

2 weeks ago


Reno, Nevada, United States Center for Orthopedic and Research Excel Full time
Job Overview

The Referral Coordinator plays a vital role in ensuring seamless patient experiences within the orthopedic practice. This position involves managing patient registration and coordinating necessary referrals and authorizations to facilitate efficient care delivery.


Key Responsibilities
  • Ensure accurate patient registration by verifying and updating information in the practice management system.
  • Obtain necessary authorizations and benefit verifications for all outpatient visits, procedures, and services.
  • Utilize online verification systems to confirm insurance eligibility and maintain accurate records.
  • Create and manage referrals for pending visits, ensuring all patient demographic and insurance information is up-to-date.
  • Prepare charts daily to support a smooth check-in process for patients and clinic staff.
  • Research and gather information required for the registration process from various sources.
  • Process a high volume of referrals daily, ensuring timely communication with primary care providers and insurance companies.
  • Monitor and inform front office staff of any outstanding patient balances.
  • Maintain productivity rates while ensuring timely claims reimbursement and managing work queues effectively.
  • Address inquiries from in-house providers and support staff regarding patient referrals and care coordination.
  • Identify trends and potential issues, communicating them to management for resolution.
  • Index referrals to existing patient accounts and create new accounts for non-established patients.

Qualifications
  • High school diploma or equivalent is preferred.

Experience
  • Two to three years of experience in a healthcare setting, particularly in referral management, front desk operations, or billing.
  • Effective communication skills with the ability to build relationships with physicians, patients, and colleagues.
  • Familiarity with Centricity Practice Management and Centricity EMR is advantageous.

Requirements
  • Experience with managed care insurances, including the process of requesting referrals and verifying benefits.
  • Comprehensive understanding of insurance plan requirements for both Medicaid and commercial plans.

Knowledge
  • Proficient in eligibility verification and prior authorization processes for various insurance payers.
  • Understanding of government regulations and billing guidelines, including Coordination of Benefits.
  • Advanced computer skills, particularly with Windows-based applications.

Skills
  • Adept at managing challenging situations while maintaining a pleasant demeanor.
  • Proficient in using computer programs and applications effectively.
  • Skilled in fostering positive working relationships with both internal and external stakeholders.

Abilities
  • Capable of multitasking in a dynamic environment.
  • Detail-oriented with strong organizational capabilities.
  • Able to interpret patient demographic information and assess insurance eligibility.
  • Typing speed of at least 45 words per minute.

Work Environment
  • Standard office environment.

Physical and Mental Demands
  • Requires typical office-related sitting and standing.
  • Some bending and stretching may be necessary.
  • Manual dexterity for operating a computer keyboard and calculator.

Organizational Expectations
  • Adherence to the mission, vision, and values of the organization is essential.


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