Referral Specialist
JOB SUMMARY
The Referral Specialists impact reimbursement through obtaining accurate referral and global authorization information from provider offices, patients and insurance carriers for all MMA providers. Works under general supervision and is responsible for timely resolution of provider/patient requests for referrals or global authorizations. Strives for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience. Recognizes and demonstrates understanding of patient and family centered care.
PRIMARY JOB RESPONSIBILITIES
- Obtain Referrals and Global Authorizations
- Schedule outside testing and appointments for MMA patients
- Track and enter necessary information into the MMA EHR system.
- Contact Insurance carriers for testing and appointment approval/authorization
- Communicate with providers, staff and patients
- Respond to internet communication, EHR clinical messages, telephone and fax communication from referral sources and/or providers
- Achieve and maintain acceptable productivity levels
- Maintain confidentiality of patient information and ensure patients’ right to privacy.
- Adhere to and contribute to the development of policies and procedures.
- Demonstrate flexibility in response to unexpected changes in work volume, staffing and scheduling.
- Resolve patient complaints by identifying and resolving issues presented
- Perform other duties as assigned by Management.
- Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior.
DEPARTMENTAL AND ADDITIONAL JOB RESPONSIBILITIES
- Maintains continuous professional development through attending seminars, reading materials and other educational sources
- Assists with training/orientation of new employees and students.
- Assists with development and updates of the Referral Center user manual.
JOB SPECIFICATIONS
EDUCATION
- High School diploma or equivalent required.
- Certified Medical Assistant, Medical Administration Specialist or Insurance Biller preferred, but not required.
EXPERIENCE
- Minimum of two years of experience in a medical office required.
ESSENTIAL PHYSICAL ABILITIES/MOTOR SKILLS
These physical requirements are not exhaustive and additional job-related physical requirements may be added on an as needed basis. Corrective devices may be used to meet physical requirements.
- Sedentary Work: Frequently required to stand, kneel and crouch. On a daily basis may be required to move about, sit, climb stairs and bend. Is frequently required to lift and carry up to 20 lbs. May be required to push/pull/carry items between 20-100 lbs.
- Vision: Requires the ability to perceive the nature of objects by the eye. Near acuity: Clarity of vision at 20 inches or less. Midrange Acuity: Clarity of vision at distances of more than 20 inches and less than 20 feet.
- Motor Coordination: While performing the duties of the job, it is required to regularly perform functions that include using hand and finger movement, handle or feel objects, be able to use tools or equipment that requires reaching with hands and arms. Must be able to travel independently throughout the hospital; access patients/families including areas confined by space and/or equipment.
- Speaking/Hearing: Ability to give and receive information through speaking and listening.
ESSENTIAL TECHNICAL ABILITIES
- Proficiency using modern office, computer and telephone equipment as used by Memorial Healthcare.
- Understanding of patient demographics, insurance registrations, insurance carriers’ guidelines, web sites and authorization processes.
- Must have a working knowledge of ICD10cm, CPT and HCPCS.
ESSENTIAL MENTAL ABILITIES:
- Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations.
- Ability to read and interpret a variety of documents including, but not limited to policies, operating instructions, white papers, regulations, rules and laws.
ESSENTIAL SENSORY REQUIREMENTS:
- Able to see for the purpose of reading information received in formats including but not limited to paper, computer, reports, bulletins, updates, manuals.
- Able to see and hear for work-related purposes.
INTERPERSONAL SKILLS:
- Ability to interact with co-workers, hospital staff, administration, patients, physicians, the public and all internal and external customers in a professional and effective, courteous and tactful manner at all times, physically, verbally and in all written and electronic communication.
- Required to remain calm when adversity is encountered.
- Open, honest and tactful communication skills.
- Ability to work as a team member in all activities.
- Positive, cooperative and motivated attitude.
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