Referral Specialist - Cancer Center - FT - Augusta, GA

Wellstar Health System, Inc.; Augusta (GA); On-site; USD 42,000 - 62,000; Full time

Job summary

Wellstar Health System, Inc. in Augusta, GA is seeking a Referral Specialist to manage the referral process for ambulatory procedures, ensuring authorizations are requested, received, and recorded.

As a primary contact for staff and patients regarding authorizations, insurance plans, and codes, you will coordinate with providers, clinics, and insurers to streamline referrals and maintain accurate records.

Qualifications

• Minimum 2 years clerical experience required or medical office experience preferred.
• Experience with CPT and ICD-9 coding preferred.
• Knowledge of medical terminology and medical ethics.
• Strong time management and communication skills.
• Ability to maintain confidentiality.

Responsibilities

• Coordinates and processes authorizations.
• Acts as liaison between the specialist, primary care physician and insurance carrier to ensure appropriate authorization for specialty procedures.
• Ensures all authorizations include ICD9 / CPT codes with supporting clinical data.
• Expedite authorization process by monitoring the tapestry database.
• Updates tapestry with valid authorization codes, date of service, and insurance contact information.
• Tracks and monitors all clinic authorizations and referrals.
• Documents referrals and conversations regarding authorization requests in the EMR.
• Responds to patient insurance questions/concerns.
• Advocates for and generates appeals and assists with patient needs.
• Maintains utilization data on managed care patients.
• Responds to phone calls from patients, physician offices and insurance plans on referrals.
• Coordinates all aspects of managed care operations.
• Coordinates review of clinic authorizations with Patient Care Manager, Providers and staff as necessary.
• Researches patient eligibility and benefits; communicates with patient accounts and faxes required documentation.
• Contributes to organizational competency and core values; performs other duties as needed.

Skills

CPT & ICD-9 coding

Medical terminology

Time management

Attention to detail

Confidentiality

Education

High School Diploma General

Job description

Work Shift

Day (United States of America)

Job Summary

The Referral Specialist is responsible for handling the referral process for specialized procedures in the ambulatory setting, ensuring that appropriate authorizations are requested, received and recorded in tapestry. Acts as the primary source for staff regarding authorizations, insurance plans, and specific procedural codes. The job duties include tracking of the patients and ensuring follow through. This is a clerical position working in a clinic with multiple providers and support staff. Work situations require a poised individual, courteous manner, discretion, organization skills, and good judgment. Knowledge of all department functions and various insurance plan provisions is essential. This position requires extensive interaction with external customers to include other physician offices, insurance plans, and patients. Internal contacts include the nursing staff, providers, and centralized call center staff.

Core Responsibilities And Essential Functions

Principal Accountabilities

• Coordinates and processes authorizations
• Acts as the liaison between the specialist, primary care physician and insurance carrier to ensure appropriate authorization for specialty procedures. Communicates all insurance concerns to the specialist.
• Ensures all authorizations are requested with appropriate ICD9 / CPT codes and includes clinical data to support request.
• Expedite the authorization process by monitoring and tracking the special procedure database (tapestry).
• Updates tapestry with valid authorization codes, date of service, and insurance contact information.
• Tracks and monitors all clinic authorizations and referrals.
• Documents referrals and all conversations regarding authorization request in the electronic medical record.
• Responds to all patients insurance questions/concerns.
• Responds to all required insurance data requests in a timely manner.
• Advocate for, and generates appeals and troubleshooting patient needs.
• Maintains utilization data on managed care patients.
• Responds to all phone calls from patients, physician offices and insurance plans on referrals made.
• Coordinates all aspects of managed care operations.
• Coordinates review of all clinic authorizations with Patient Care Manager, Providers and support staff as necessary.
• Researches patient eligibility and benefits; corresponding with patient accounts and faxing requested documentation.
• Contributes to the success of the organization by meeting organizational competency expectations and core values (respect, integrity, stewardship, excellence, collaboration and kindness), continuously learning, and by performing other duties as needed or assigned.

Performs other duties as assigned

Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education

• High School Diploma General

Required Minimum License(s) And Certification(s)

All certifications are required upon hire unless otherwise stated.

Required Minimum Experience:

Minimum 2 Years Clerical Experience Required Or

medical office Preferred or

Required Minimum Skills

Experience with CPT and ICD-9 coding Preferred

Knowledge of and skill in the use of personal computer and related software.

Knowledge of medical terminology and medical ethics.

Time management, good grammar and spelling, good interpersonal skills.

Ability to deal with difficult people or situations in a professional manner.

Ability to train staff of all levels. Ability to work efficiently under pressure, with a high degree of accuracy.

Ability to work independently and take initiative.

Ability to exercise discretion and maintain confidentiality.

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.