What are the responsibilities and job description for the Referral Specialist - Talsman Primary Care position at Mercy Health BSMH?
Referral Specialist - Talsman Primary Care
Performs related duties as required.Performs related duties as required.The Referral Authorization Specialist is responsible for overseeing the daily processing of referrals in an efficient manner, facilitating patient information transfer and insurance authorization; . Utilizes effective phone and customer service skills; Enters complete and accurate information into appropriate computer system(s) - including but not limited to patient data in registration system, referring physician and patient's primary care provider.
ESSENTIAL FUNCTIONS:
Obtains verification and pre-authorization on assigned diagnostic, surgical and ancillary services.
Receives patient orders and referral faxed from referring physician's office. Communicates with the referring physician's office, other medical offices and/or patient to obtain any records (including radiology films) needed to help the physician make an informed medical decision about the patient's current medical condition. Attaches appropriate patient forms that need to be completed by the physician.
Prioritizes the urgency of patient referrals to make sure patient is seen in a timely fashion.
Communicates with the physician when the new patient cannot be seen within seven days or sooner if specified by the referring physician.
Works collaboratively with all diagnostic and surgical service areas, physician offices and hospitals to ensure timeliness, accuracy and completeness when scheduling patient appointments, tests and procedures. Consistently and accurately document the date and time of appointment, test, scan or procedure in the patient's medical record. Provides thorough directions to the clinic, verify all paperwork has been received (or instruct patient to arrive early to complete such paperwork.
Notify the appropriate area of the date and time of scheduled appointments, tests and procedures.Verifying eligibility, documenting physician direct referrals, obtaining pre-certification or authorizations of certain services as defined by the patient’s health insurance plan.
Performs related duties as required.
Minimum Qualifications:
• Minimum of one year of experience as a referral coordinator preferred. • A minimum of one year experience in a healthcare setting, healthcare insurance company, or managed care organization is required
• Knowledge of CPT procedure and ICD-10 coding required; Prior experience with an EMR system preferred; Strong analytical, organizational and time management skills; Ability to multi-task with little supervision; Ability to interact effectively and courteously with members, physicians, providers, payors, and co-workers.
Knowledge of Microsoft Word and Excel; familiar with HIPAA guidelines
Many of our opportunities reward* your hard work with:Comprehensive, affordable medical, dental and vision plans
Prescription drug coverage
Flexible spending accounts
Life insurance w/AD&D
Employer contributions to retirement savings plan when eligible
Paid time off
Educational Assistance
And much more
*Benefits offerings vary according to employment status
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com
