Referral Specialist, FT, Days

Davita Inc.; Greenville (SC); On-site; USD 35,000 - 45,000; Full time

Job summary

A leading healthcare provider seeks a Referral Specialist to enhance patient experience by managing referrals and authorizations. The role includes liaising between patients and healthcare providers, ensuring seamless communication and compliance with healthcare regulations. Ideal candidates will have strong customer service skills and relevant experience in a healthcare setting.

Qualifications

• Two years of experience in a physician front office.
• Experience with patient registration and electronic scheduling.
• Knowledge of authorization/precertification processes.

Responsibilities

• Authorize consultations, procedures, and tests.
• Document referral status and ensure follow-up.
• Assist patients with navigating the healthcare system.

Skills

Customer service

Communication

Knowledge of health insurance

Medical terminology

Data entry

Education

High School diploma or equivalent

Tools

Microsoft Office

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

To provide our patients a seamless entry in to the Prisma Health experience. The Referral Specialist interfaces with patients and physician office team members to accurately authorize various consultations, procedures and tests. The Referral Specialist utilizes each patient's preferred method of contact. The Referral Specialist utilizes various electronic medical records to transmit required clinical documentation to third party payors and Specialist Physicians. Responsibilities include documenting all actions and encounters regarding the referral including timely follow up with the patient, referring and referral physician practice and third party payors including pre-certification, cancelled and rescheduled appointments, and other events preventing closure of the referral experience.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference.

• Responsible for the authorization/precertification process to include coordinating with outside and internal organizations along with insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis and prognosis. Provides specific medical information to financial services to maximize reimbursement to the hospital and physicians.

• Accurately records demographic, coverage, and scheduling information in various systems. Reminds patients of scheduled appointments via mail, internet, or telephone. Ensures that patient's primary care chart is up to date with scheduling information about specialist consults, tests, and procedures managed. Alerts management to trends in appointment availability and appointment date timeliness.

• Promotes hospital goals towards meaningful use in the electronic medical record on behalf of the referring physician. Documents referral status and all scheduled appointments in appropriate system (electronic medical record) for referral tracking data. Responsible for following up after patient's consultation, procedure, and/or test to determine if physician has received report; continues to check on status until complete.

• Serves as Liaison between the provider, practice, patient and specialist providing the service. Provides appropriate patient clinical information and referral needs to specialist office.

• Verifies physician's orders to ensure the accuracy of results and communicates with the patient the guidelines, protocols and location.

• Assists patients in problem solving potential issues related to navigating the health care system, financial obligations or social barriers (e.g., request interpreters if appropriate, transportation services or prescription assistance). May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.

• Promptly responds to patient's scheduling requirements (date and time), questions and concerns to ensure patient experience expectations are met or exceeded.

• Ensures timely appointments are booked, reviews details and expectations about the referral process with patients.

• Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by Prisma Health.

• To ensure the effective and efficient operation of the facility and to create an extraordinary patient, physician and team member experience.

• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Experience

• Education - High School diploma or equivalent

• Experience - Two (2) years of comparable experience, preferably in a physician front office to include patient registration and/or electronic scheduling and the authorization/precertification process.

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills or Abilities

• Excellent customer service skills

• Excellent oral and written communication skills and interpersonal skills

• Knowledge of various health insurance companies.

• Knowledge of medical terminology, CPT and Diagnosis Coding, insurance verification and updates, and the authorization/precertification process.

• Knowledge of Microsoft office products. Must pass data entry test 85 kst. with 90% accuracy.

Work Shift

Day (United States of America)

Location

Centennial Way Practices

Facility

2444 MCCW-Urology

Department

24441000 MCCW-Urology-Practice Operations

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.