Referral Specialist, Pulmonology, FT, Days

Prisma Health; Columbia (SC); On-site; USD 25,000 - 39,000; Full time

Job summary

Prisma Health in Richland, SC seeks an organized front office specialist to manage referrals, precertifications, and patient scheduling. You will work with patients, physician offices, and third-party payors to obtain prior approvals and transmit clinical documentation.

You will document all actions, follow up on referrals, and maintain HIPAA compliance while delivering compassionate patient service. This role supports the Practice Operations department on site at Pulmonology 1 Med Park 300.

Qualifications

• Patient registration and/or electronic scheduling experience preferred.
• Experience with authorization/precertification processes preferred.
• Knowledge of health insurance processes and third-party payor communications.
• Familiarity with CPT/Diagnosis Coding and medical terminology.

Responsibilities

• Coordinate with outside and internal organizations and insurance companies to obtain prior approvals.
• Record demographic, coverage, and scheduling information in systems.
• Remind patients of appointments and ensure up-to-date PCP data.
• Document referral status and communicate with physicians and payors.
• Follow up after consults/tests to confirm reports are received.
• Maintain patient confidentiality and HIPAA compliance.
• Provide high-quality patient service and problem-solve barriers to care.

Skills

Customer service

Communication

Interpersonal skills

Health insurance knowledge

Medical terminology

CPT and Diagnosis Coding knowledge

Insurance verification

Authorization/precertification process

Microsoft Office

Education

High School diploma

Tools

Microsoft Office

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Provides patients a seamless entry into the Prisma Health experience. Interfaces with patients and physician office team members to accurately authorize various consultations, procedures and tests. Utilizes each patient’s preferred method of contact. 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 purpose: 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.
• 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.
• 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.
• Ensures 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 preferred
• Experience - Two (2) years of related work experience. Experience in a physician front office to include patient registration and/or electronic scheduling and the authorization/precertification process preferred

In Lieu Of

• In lieu of education/experience noted above, equivalent work and/or experience may be considered (i.e., Associate degree or higher level of education)

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills or Abilities

• Customer service skills
• Communication skills
• 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.

Work Shift

Day (United States of America)

Location

1 Medical Park Rd Richland

Facility

Pulmonology 1 Med Park 300

Department

Pulmonology 1 Med Park 300-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.