Orthopedics Referral Navigator & Authorization Expert

Banner Medical Group; United States; On-site; USD 25,000 - 30,000; Full time

Benefits offered by this job

Comprehensive benefits

Job summary

Banner Health seeks a Referral Specialist to coordinate referral orders for continued treatment within a primary care setting in Gilbert, AZ. You will prepare and transmit necessary clinical information for payor authorization and work with payors, facilities, and providers to ensure timely services.

You will track referrals at 30/60/90 days, educate patients, and liaise with outside referral sources to close care gaps while maintaining HIPAA compliance and a high standard of customer service.

Qualifications

• High school diploma/GED or equivalent.
• 1 year direct patient interaction/experience in medical, insurance, or healthcare related industry.
• Knowledge of HIPAA regulations.
• Strong customer service focus and willingness to problem solve.
• Effective verbal and written communication skills and the ability to manage competing priorities.
• Must be proficient with commonly used office software.

Responsibilities

• Schedules appointments for specialty physician services and diagnostic testing per provider request and communicates with the patient on a timely basis for all scheduling requirements.
• Acts as a liaison between patients, providers and staff members for patients’ referral and follow up needs. Provides prompt and professional service for the patients by assisting in educating patient/family and assisting patients with external resources when needed.
• Provides all pertinent clinical information needed for the payor authorization, the facility or specialist prior to the services being rendered by verifying coverage, obtaining authorization and communicating with receiving facilities
• Tracks and manages all referrals by monitoring outstanding referrals at 30/60/90 day intervals and following up with patients if appointments are not kept
• Applies knowledge of medical terminology and maintains up to date knowledge of insurance environment. Utilizes internal and external resources to seek knowledge about regulations regarding various payor sources
• Collaborates with outside referral sources and other community resources. Maintains an updated list of community resources and networks with colleagues to develop additional referral sources
• This position has frequent communications with patients, physicians, staff, and third party payers. The position must work with and understand the concepts of managed health care and be able to prioritize tasks within established guidelines with moderate supervision

Skills

Customer service

Verbal and written communication

HIPAA regulations

Office software

Patient interaction (1 year)

Education

High school diploma/GED

Job description

Banner Health seeks a Referral Specialist to coordinate referral orders for continued treatment within a primary care setting in Gilbert, AZ. You will prepare and transmit necessary clinical information for payor authorization and work with payors, facilities, and providers to ensure timely services.

You will track referrals at 30/60/90 days, educate patients, and liaise with outside referral sources to close care gaps while maintaining HIPAA compliance and a high standard of customer service.