The Referral Specialist works with patients requiring a referral for a test or to a specialist office, to ensure patient?s referral needs are fulfilled for tests and specialty service office visits.
Processes orders for tests and referrals, authorizations and pre-certifications for patients, to ensure timely reimbursements.
Follows up on all test and referrals to specialist office until the documentation is received and scanned into the system for reconciliation.
Gather, verify, and process orders for test, referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.
Communicate detailed information and answers patients' questions regarding their health care plan; provide answers to billing and insurance clarification questions.
Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc.
Communicates or gives written material to patients with referral information such as date, time, and location, as well as contact information to ensure patient has resources to review if needed.
Coordinate flow of information between medical clinic and patients insurance for referral authorization to secure a valid referral for clinic patient.
Enter and annotate testing information and referrals, does e-referral for applicable practices for meaningful use and follows-up to make sure e-referral and or faxed referrals are received, documents communications and action into PPMS and AEHR, as appropriate.
Maintains supply of contrasting prep for testing so that when patients are scheduled the prep can be given to the patient and the patient can be educated as to the prep.
Otherwise patients are told to be at the testing site 1 ½ hours early for prep.
Notify physician(s) and patient when test or referral is denied, or if additional information is needed.
Develop and maintain database of referral physician offices preferred by each physician within the clinic.
Maintains complaint resolution and solutions related to patient referrals.
Calls or faxes for test and referral documents, documents in notes when attempts are made to reconcile the test or referral.
Scans the documents into the system and closes the order or referral.
Documents all test and referrals in PPMS and AEHR for outmigration reporting.
Knowledge of clinic referral and scheduling processes and billing/authorization requirements.
Knowledge of federal and state pay requirements, including Medicare, DSHS, HMO/PPO Contracts.
Ability to communicate effectively and to maintain strict confidentiality.
Ability to respond to people and issues promptly and appropriately, to resolve problems.
A team player who handles multiple projects simultaneously in a fast paced environment.
Possess a strong work ethic and a high level of professionalism
Perform other duties as assigned by the practice manager or physicians.Education:
High school diploma or equivalent required
2 years of progressively responsible related experience in a healthcare environment required.
Electronic medical record experience preferred
Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
Adheres to and exhibits our core values:
Reverence: Having a profound spirit of awe and respect for all creation, shaping relationships to self, to one another and to God and acknowledging that we hold in trust all that has been given to us.
Integrity: Moral wholeness, soundness, uprightness, honesty and sincerity as a basis of trustworthiness.
Compassion: Feeling with others, being one with others in their sorrows and joys, rooted in the sense of solidarity as members of the human community.
Excellence: Outstanding achievement, merit, virtue; continually surpassing standards to achieve/maintain quality.
Maintains confidentiality and protects sensitive data at all times.
Adheres to organizational and department specific safety standards and guidelines.
Works collaboratively and supports efforts of team members.
Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.
Catholic Health Initiatives and its organizations are Equal Opportunity Employers
This position requires a criminal background check.
Therefore, you may be required to provide information about your criminal history in order to be considered for this position.
Additional Information Requisition ID: 2020-R0276833
Schedule: Full-time Shift: Day Job
Market: CHI Memorial
About this company
Memorial Health Care System is a not-for-profit, faith-based healthcare organization dedicated to the healing ministry of the Church. Founded by the Sisters of Charity of Nazareth and strengthened as part of Catholic Health Initiatives, it offers a continuum of care including preventative, primary and acute hospital care, as well as cancer and cardiac care, orthopedic and rehabilitation services. Memorial is a regional referral center of choice with 4,000 associates and more than 700 affiliated physicians providing health care throughout Southeast Tennessee and North Georgia. Memorial Health Care System is recognized as one of the nation's 100 Top Hospitals® by Thomson Reuters, the health care industry's leading source of information on hospital quality.
Location/Region: Chattanooga, TN (37404)