Referral Rep

Reports to the Manager/Director and works under the direction of the Office Supervisor. Under general supervision and according to established policies and procedures. Responsibilities include Receptionist duties as well as scheduling specialty and/or diagnostic procedures, knowledge of ICD-10, CPT and online Authorizations. Assists in coordinating healthcare services to a large outpatient client population. Verifies insurance eligibility when appropriate for the physician office and/or member.

MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Performs routine reception and clerical duties in accordance with established policies and procedures by:

• Receiving and greeting patients and visitors and checking in patients for their appointments.
• Receiving telephone calls, taking and relaying messages accurately.
• Obtaining information from the patient to accurately complete the patient record for payment information, computer input, etc.
• Maintaining patient files, charts, and records.
• Maintaining good rapport and cooperative working relationship with all members of the medical offices, other medical offices, hospital services, and community agencies.
• Maintaining technological competencies, organization, and neatness in the work area.
• Completing all mandatory in-services in required time frame.
• Assisting co-workers as needed.
• Acting as liaison between provider offices, physicians, health plans and other departments to ensure high-quality customer service are being delivered.

Performs Referral duties in accordance with established policies and procedures by:

• Performing online insurance eligibility/authorizations, and scheduling diagnostic/specialty referrals.
• Resolving re-certification, registration and case-related concerns prior to a patient's appointment
• Gathering pertinent information from insurance carriers, financial counselors, and other ancillary staff to make certain the patient's financial obligations for services provided.
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• Providing support to clinical staff in order to facilitate the administrative components of clinical referrals for various services.
• Acting as a liaison between hospitals, physicians, health plans, vendors, and patients, or other referral sources.
• Verifying insurance coverage and obtains authorizations if needed from insurance coverage.
• Entering referrals and documents communications, actions, and other data in an information system
• Evaluating current processes for enhancement and make necessary recommendations.

Patient care duties, as directed by the physician or nurse, by:

• Interpreting physician's instructions to patients and providing instruction to patients.
• May schedule imaging and diagnostic procedures.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department.

• Attending required meetings and participating in committees as requested.
• Enhancing professional growth and development through in-service meetings and educational programs as approved.
• Completing other job-related duties and projects as assigned.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

Education and Experience

• The knowledge, skills and abilities as indicated are normally acquired through the successful completion of a high school diploma or equivalent; Previous medical office experience, ICD-10, CPT, online insurance eligibility/authorizations, and specialty/diagnostic referral experience preferred.

Knowledge & Skills

• Demonstrates well developed communication skills to communicate effectively and clearly to a variety of internal and external contacts.
• Knowledgeable in ICD-10, CPT, online insurance eligibility/authorizations, and scheduling diagnostic/specialty referrals.
• Knowledge of Allscripts, Cerner, referral database, excel, word, outlook, and net learning.
• Knows and adheres to all laws and regulations pertaining to patient health, safety and medical information.
• Demonstrates analytical skills necessary to solve patient problems and interpret data.
• Promotes collaboration and innovation in the clinical services to ensure an interdisciplinary approach to improving health care delivery and the quality of patient care.
• Must be tactful in handling patient problems often of a highly personal and confidential nature.
• Must be able to maintain professionalism during frustrating interpersonal situations.

Working Conditions

• Assigned hours within your shift, starting time, or days of work are subject to change based on departmental and/or organizational needed.
• May need to travel to other Beacon locations.
• Understands and strives for providing excellent customer service.
• Ability to adjust communication skills to the level of the patient.
• Works under direct supervision, but requires independent critical thinking skills and extensive problem solving skills.

Physical Demands

• Requires the physical ability and stamina to perform the essential functions of the position.