What are the responsibilities and job description for the Referral Center Representative position at UnityPoint Health?
- Area of Interest: Patient Services
- FTE/Hours per pay period: 1.0
- Department: Referral and Prior Auth Mgmt
- Shift: Monday-Friday 8:00AM-5:00PM
- Job ID: 183453
UnityPoint Clinic
Referral Center Representative
Monday Friday Shift: 8am - 5pm
The Referral Center Representative is responsible for coordinating patient referrals, scheduling specialty exams, obtaining insurance pre-authorizations, and ensuring accurate documentation to ensure timely and accurate healthcare access. The role acts as a liaison between patients, healthcare providers, and third-party payers to facilitate seamless communication and care coordination.
Why UnityPoint Health?
At UnityPoint Health, you matter. We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members.
Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in. Here are just a few:
- Expect paid time off, parental leave, 401K matching and an employee recognition program.
- Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members.
- Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family.
And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience.
Find a fulfilling career and make a difference with UnityPoint Health.
Responsibilities
- Works on patient referrals by coordinating appointment scheduling and ensuring the timely and accurate processing of referral requests, initiating referrals within 24 hours on business days, and documenting all stages in Electronic Medical Records (EMR) systems.
- Coordinates and schedules specialty exams, diagnostic tests, and outpatient services as needed, ensuring proper authorization and documentation.
- Obtains and documents insurance pre-authorizations and approvals from Third-Party Payers (TPP) for services as required.
- Tracks and monitors referrals, ensuring proper documentation and follow-ups for injury cases, and maintains accurate referral reports for management. Acts as a liaison between patients, providers, employers, insurance companies, attorneys, and healthcare facilities to ensure seamless communication, care coordination, and timely notification of appointments and procedure instructions.
- Monitors and distributes incoming faxes, voicemails, and messages, forwarding them to appropriate personnel as required.
- Completes necessary forms and requisitions for referrals and diagnostic testing, ensuring accurate Current Procedural Terminology (CPT) / International Classification of Diseases, 10th Revision (ICD-10) coding for billing and insurance purposes.
- Maintains current knowledge of payer-specific prior authorization requirements, attending virtual workshops and reviewing updates from insurance providers.
- Registers patients, verifies demographic and insurance information, and assists scheduling of office staff to optimize patient flow.
- Supports quality improvement initiatives by tracking referral trends, identifying delays, and implementing workflow optimizations.
- Ensures adherence to the Health Insurance Portability and Accountability Act (HIPAA) regulations, maintaining patient confidentiality while handling sensitive information.
Education:
- High School Diploma or equivalent required.
- IA/IL Child Abuse Mandatory Reporter Training in state(s) where providing care required within 90 days of hire.
- IA/IL Dependent Abuse Mandatory Reporter Training in state(s) where providing care required within 90 days of hire.