Referrals Specialist

2 months ago

Little Rock, United States CARTI Full time

Responsible for obtaining required insurance referrals and physician consultation authorizations from patient insurance carriers. Acts as a liaison between patient, physician and insurance company by performing activities in a friendly, courteous and professional manner.

JOB SPECIFIC DUTIES AND RESPONSIBILITES:

To ensure required referrals and consultation authorizations have been obtained correctly for medical specialty visits in a timely manner. Support the patient privacy/confidentiality policies and regulations under HIPAA for patients and their medical records. Educate the patients on various policies, procedures, and benefits related to the need for referrals. Providing support to the revenue cycle department, as needed. Enters referrals and documents communications, actions and other data in an information system. Maintain ongoing tracking and appropriate documentation on referrals for all patients to promote team awareness. Demonstrates the skills of effective communication, decision-making and organization to ensure efficient job performance and job success. Make outbound calls and oversees inbound and/or review correspondence received via fax or email efficiently, with a high touch and exceptional customer service to callers. Daily work is accomplished with minimal direct supervision. Assists other departments as directed.

SUPERVISORY RESPONSIBILITY: N/A

EDUCATION, CERTIFICATION, LICENSURE and REGISTRATION:

High school graduate or equivalent required.

EXPERIENCE, KNOWLEDGE, SKILLS and ABILITIES:

Minimum of 2 years of related medical insurance referral experience. Skilled with excellent customer service. Ability to take and follow through with delegated tasks and accountability. Ability to work cooperatively as a team member of the Patient Advocacy Department. Ability to accurately enter data and examine insurance documents. Ability to read, understand and follow oral and written instructions. Ability to communicate clearly and concisely. Ability to establish and maintain effective working relationships with patients, employees and the public. Knowledge of computer programs, applications and other basic office equipment skills. Excellent problem-solving skills and extremely detail oriented.

REASONING ABILITY:

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, or schedule form.

INTERPERSONAL SKILLS:

Must interact and communicate both verbally and in written form. Must interact and exchange information regarding patients with physicians and other departmental personnel, and outside agencies on a frequent basis while respecting the confidentiality of patient information.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. 

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. Specific vision abilities required by this job include close vision and the ability to adjust focus.

WORK ENVIRONMENT:

The work environment described here are representative of those an employee encounters while performing the essential functions of this job. This position involves potential exposure to infectious diseases. Colleagues are offered appropriate vaccinations and safety training.

COMMENTS:

This description is intended to describe the essential job functions, the general supplemental functions and the essential requirements for the performance of the job. It is not an exhaustive list of all duties, responsibilities and requirements of a person so classified. Other functions may be assigned and management retains the right to add or change the duties at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.

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