Referral Specialist Fulltime

Employment Type:
Full timeShift:

Description:
Would be working on prior authorizations and radiology requests

Key Responsibilities (list 5-8)

· Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with

physician(s), patients, and payers.

· Communicate detailed information and answers patients’ questions regarding their health care

plan; provide answers to billing and insurance clarification questions.

· Set up appointments, coordinate clinic visits, and any special arrangements such as

transportation, interpreter services, specialty care, etc.

· Coordinate flow of information between medical clinic and referral authorization department to

secure a valid referral for clinic patient.

· Enter referrals, documents communications and action into the system, as appropriate.

· Notify physician(s) and patient when referral is denied, or if additional information is needed.

· Develop and maintain database of referral physician offices preferred by each physician within

the clinic.

· Assist Practice Manager with complaint resolution and solutions related to patient referrals.

· Perform other duties as assigned by the practice manager or physician.

III. CHI Core Expectations

At CHI, we expect all our employees to live the values of Reverence, Integrity, Compassion and

Excellence at work by:

· Honoring and caring for the dignity of all persons in mind, body, and spirit

· Ensuring the highest quality of care for those we serve

· Working together as a team to achieve our goals

· Improving continuously by listening, and asking for and responding to feedback

· Seeking new and better ways to meet the needs of those we serve

· Using our resources wisely

· Understanding how each of our roles contributes to the success of CHI.

IV. Core Job Competencies

Core CHI Behaviors: The following behaviors have been identified as critical to all staff roles at CHI:

· Teamwork Orientation: works cooperatively & collaboratively with others toward the

accomplishment of shared goals.

· Service Orientation: desire to serve and focus one’s efforts on discovering and meeting the

needs of internal and external customers.

· Achieves Results: reflects a drive to achieve and outperform. Continuously looking for

improvements. Accepts responsibility for actions and results.

· Learning and Growth: has a commitment to continuous professional and organizational

learning · Communication: practices attentive and active listening and can restate opinions of others; communicates messages in a way that has the desired effect. Role-Specific Behaviors: these additional behaviors are necessary in the role: · Knowledge of clinic referral and scheduling processes and billing/authorization requirements. · Knowledge of federal and state pay requirements, including Medicare, DSHS, HMO/PPO Contracts. · Ability to communicate effectively and to maintain strict confidentiality. · Ability to respond to people and issues promptly and appropriately, to resolve problems. · A team player who handles multiple projects simultaneously in a fast paced environment. · Possess a strong work ethic and a high level of professionalism. Skills, Knowledge or Abilities critical to this role: · Language Ability: Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to common inquiries or complaints from groups of managers, clients, customers, and the general public. · Math Ability: Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. · 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, diagram, or schedule form. · Computer Skills: Must be proficient with the Microsoft Office Suite, Internet navigation, database management, desktop publishing, spreadsheet, and graphic presentation packages.

V. Job Requirements / Qualifications

a. Education / Accreditation / Licensure (required & preferred):

· High school diploma or equivalent required.

b. Experience (required and preferred):

· 2 years of progressively responsible related experience in a healthcare environment required.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Tagged as: Specialist