Referral Specialist Orthopedics

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

Primary City/State: Gilbert, Arizona

Department Name: C/P-BGMC Ortho-Clinic Work Shift: Day Job Category: Administrative Services

Health care is constantly changing, and at Banner Health, we are at the front of that change. We are leading health care to make the experience the best it can be. We want to change the lives of those in our care - and the people who choose to take on this challenge. If changing health care for the better sounds like something you want to be part of, we want to hear from you. Banner is seeking a dedicated and detail-oriented Referral Specialist. This role focuses on supporting Banner-ordered referrals while leveraging extensive knowledge of Cerner's referral management tool and a strong understanding of insurance requirements and authorization processes.

Location: 1920 N. Higley Rd. Suite 306 Gilbert, AZ 85234 Hours: Monday-Friday 8am-5pm

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

• 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

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.

EEO STATEMENT

EEO/Disabled/Veterans Our organization supports a drug-free work environment.

COMPANY OVERVIEW

Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

BENEFITS

• We are proud to offer a comprehensive benefit package for all benefit-eligible positions.
• Please visit our Benefits Guide for more information.