What are the responsibilities and job description for the Referral Specialist 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: 163777
UnityPoint Health Information
Why UnityPoint Health?
Commitment to our Team – 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.
Culture – At UnityPoint Health, you matter. Come for a fulfilling career and experience a culture guided by uncompromising values and an unwavering belief in doing what's right for the people we serve.
Benefits – Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in.
- Caring is what we do, and it starts with our team members: expect paid time off, parental leave, 401K matching and an employee recognition program as we support you both personally and professionally.
- You can only give your best when you feel your best, and we help you live well with dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members to give you peace of mind.
- We strive to make things easier and more personal in health care to set us apart from the rest, and you can experience that commitment through early access to earned wages with Daily Pay, a tuition reimbursement program designed to help you further your career and adoption assistance to help you grow your family in the way that works for you.
Diversity, Equity and Inclusion Commitment – At UnityPoint Health, we honor the ways people are unique and embrace what brings us together. Our collective goal is to champion a culture of belonging where everyone feels valued and respected.
Development – We believe equipping you with support and development opportunities is an essential part of delivering a remarkable employment experience.
Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve.
Hear more from our team members about why UnityPoint Health is a great place to work at https://dayinthelife.unitypoint.org
Overview
Referral Specialist
Monday-Friday 8:00AM-5:00PM
Full Time Benefits
As a Referral Specialist at UnityPoint Clinic, you'll play a pivotal role in managing the seamless coordination of patient referrals within our healthcare ecosystem. You will be entrusted with overseeing the entire referral process, ensuring a smooth transition from the initial receipt of the referral from providers to effective communication with patients. This position requires meticulous attention to detail, excellent organizational skills, and a commitment to delivering exceptional customer service to our clinical teams and patients alike.
Responsibilities
Coordination of Patient Appointments & Authorizations
• Manage and oversee the entirety of the patient referral process, from intake to completion, ensuring accuracy and timeliness at each stage.
• Schedule visits with specialists or outpatient services, aligning with patient preferences and provider recommendations.
• Complete thorough documentation within the Electronic Medical Record (EMR), maintaining precise and up-to-date records of all referral-related information.
• Communicate effectively and efficiently with referring offices, specialists, and patients to relay pertinent referral information, ensuring clarity and comprehension on all sides.
• Collaborate closely with clinical teams to streamline processes and optimize patient care delivery.
• Uphold the highest standards of customer service and professionalism, both internally within our clinic and in interactions with external stakeholders, demonstrating professionalism and empathy at all times.
• Support the maintenance of standard processes and procedures for workflows, payer specific requirements, and external referral partner information.
• Actively participate as a supportive team member, contributing positively to a collaborative work environment and fostering a culture of mutual respect and teamwork.
Correspondence with Patients
• Communicates to patient about scheduled tests/procedures, appointment details, and insurance coverage via appropriate communication channels.
• Notifies patient of any instructions and explanations of tests/procedures to patients per protocols.
• Utilizes exemplary customer service skills with every patient interaction.
Obtain Pre-Certifications and Prior Authorizations
• Obtain pre-certifications or prior authorizations as required for referrals.
• Collaborate closely with healthcare providers and insurance companies to obtain necessary prior authorizations and pre-certifications for referred services or treatments.
• Navigate insurance protocols and policies to ensure compliance with specific requirements for different procedures or specialist visits.
• Maintain up-to-date knowledge of insurance coverage and authorization processes, staying informed about any changes or updates in insurance regulations that may affect the referral process.
• Support the maintenance of standard processes and procedures for workflows, payer specific requirements, and external referral partner information.
• Advocate for patients when dealing with insurance companies to ensure timely approval of necessary treatments or services, addressing any issues that may arise during the authorization process.
• Document and track authorization statuses meticulously within the Electronic Medical Record (EMR) system, ensuring accuracy and completeness of all related information.
• Communicate professionally and effectively with healthcare providers, patients, and insurance representatives to convey authorization status updates and requirements, ensuring all parties are informed and aligned throughout the process.
Qualifications
Education
• High School diploma or equivalent.
Experience
• 2-3 years previous experience in medical field.
• Basic knowledge of medical terminology, anatomy, and physiology.
License(s)/Certification(s)
• Valid driver’s license when driving any vehicle for work-related reasons.
Knowledge/Skills/Abilities
• Outstanding interpersonal and communication abilities, both written and verbal and ability to interact effectively with internal and external customers.
• Excellent organizational skills with an acute attention to detail.
• Ability to work collaboratively within a multidisciplinary team environment.
• Writes, reads, comprehends, and speaks fluent English.
• Multicultural sensitivity.
• Microsoft Office – basic computer skills.
• Critical thinking skills using independent judgment in making decisions.
• Ability to understand and apply guidelines, policies, and procedures.