Referral Specialist OBGYN

bannerhealth; Chandler (AZ); On-site; USD 42,000 - 52,000; Full time

Job summary

Banner Health’s Chandler OB/GYN clinic is seeking a Referral Specialist to manage referral orders for continued treatment, verify insurance eligibility, and attach authorizations to patient charts. You will interact with patients by phone to schedule and educate, ensuring timely referrals and accuracy in documentation.

You’ll work Monday to Friday, 7:30am-4:00pm, in a team-focused environment that values growth, service excellence, and patient experience.

Qualifications

• High school diploma or GED or equivalent.
• 1 year of direct patient interaction in medical/healthcare.
• Knowledge of HIPAA regulations.
• Strong customer service focus and problem-solving ability.
• Proficient with commonly used office software.

Responsibilities

• Schedules referrals and coordinate with patients for specialty services and tests.
• Acts as liaison between patients, providers and staff for referrals and follow-ups.
• Verifies coverage and obtains authorization prior to services.
• Tracks referrals at 30/60/90 day intervals and follows up with patients.
• Maintains knowledge of insurance processes and regulations.

Skills

Patient interaction

Healthcare experience

HIPAA knowledge

Customer service

Verbal communication

Education

High school diploma/GED

Tools

EMR systems

Office software

Job description

Primary City/State:

Chandler, Arizona

Department Name:

C/P-Chandler OB/GYN-Clinic

Work Shift:

Day

Job Category:

Administrative Services

Health care is changing, and it’s our goal to create a new model to answer America's health care challenges today and in the future. Our passionate and talented teams will be the change on the health care landscape in our communities – big and small. If taking access and delivery from complex to easy, from costly to affordable and from unpredictable to reliable sounds interesting to you, we want to hear from you.

As a Referral Specialist you will verify and update patient registration information in the system/chart. Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all specialty consultations and follow ups, uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility; attaches referrals and authorizations to patients’ chart for billing purposes; will process roughly 50 referrals a day; and assist with phones as needed. We are an engaging team with a definite potential for growth. Bring your desire to learn and grow with us to our ever-growing GYN clinic, where you’ll be working side by side with medical staff to create a great patient experience. A love for working with adult patients over the phone, is a definite plus. Bring your dedication and determination to succeed. You will have a daily opportunity to learn new things and utilize your decision-making skills to make a difference in the lives in our patients.

This position is located 1125 S Alma School Rd. Suite 210 Chandler AZ 85286 The schedule will be Mon-Fri 7:30am-4:00pm

Banner Health has been recognized by Becker’s Healthcare as one of the 150 top places to work in health care. In addition, we recently made Newsweek’s list of America’s Greatest Workplaces 2023 for Diversity.

These recognitions reflect Banner Health's investment in team members' professional development, wellness benefits, and continued education. It highlights our commitment to advocating for diversity in the workplace, promoting work-life balance, and boosting employee engagement.

At Banner Medical Group, you'll have the opportunity to perform a critical role in the community where you practice. Banner Medical Group provides both primary and specialty care throughout the communities in which Banner Health operates. We do this in a variety of settings - from smaller group practices like our Banner Health Clinics in Colorado and Wyoming, to large multi-specialty Banner Health Centers in the metropolitan Phoenix area. We currently have more than 1,000 physicians and more than 3,500 total employees in our group and are seeking others to enhance our ability to deliver our nonprofit mission of providing excellent patient care.

POSITION SUMMARY

This position is responsible for coordinating referral orders for a continuation of treatment, such as specialty services and diagnostic testing within a primary care practice. This position provides all pertinent clinical information needed for the payor authorization and the facility or specialist prior to the services being rendered. The position is responsible for tracking and managing all referrals with the intention and outcome to close any patient care gaps, along with providing documentation to promote team awareness.

CORE FUNCTIONS

1. 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
2. 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.
3. 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
4. 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
5. 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
6. 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
7. 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

MINIMUM QUALIFICATIONS

High school diploma/GED or equivalent working knowledge.

Possesses 1 year of direct patient interaction/experience in a 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.

PREFERRED QUALIFICATIONS

Previous knowledge of managed care concepts. Working knowledge of medical terminology and ICD-9 and CPT codes.

Additional related education and/or experience preferred.

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