Referral Specialist/Scheduler

MercyOne; Newton (IA); On-site; USD 36,000 - 48,000; Full time

Job summary

A leading healthcare provider in Newton, IA is seeking a Referral Specialist/Scheduler to facilitate patient referrals and authorizations for specialty services. This role engages in active communication with patients and healthcare providers while ensuring compliance with billing requirements. Ideal candidates will have a high school diploma and a commitment to providing excellent patient care.

Qualifications

• High school diploma or equivalent preferred.
• Basic Life Support (BLS) certification must be obtained within three months of hire.
• Completion of Mandatory Reporter abuse training required within three months.

Responsibilities

• Gather and process referrals, authorizations, and pre-certifications.
• Communicate information and answer patient questions about healthcare plans.
• Coordinate appointments and special arrangements for patients.

Skills

Communication

Confidentiality

Teamwork

Education

High school diploma or equivalent

Basic Life Support (BLS)

Job description

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Description:

The Referral Specialist works with patients requiring a referral, to ensure patient’s referral needs are fulfilled for specialty service office visits. Processes referrals, authorizations and pre-certifications for patients, to ensure timely reimbursement.

Employment Type

Full time

Shift

Description:

The Referral Specialist works with patients requiring a referral, to ensure patient’s referral needs are fulfilled for specialty service office visits. Processes referrals, authorizations and pre-certifications for patients, to ensure timely reimbursement.

Key "Responsibilities

• Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.
• Communicate detailed information and answers patients' questions regarding their health care plan; provide answers to billing and insurance clarification questions.
• Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc.
• Coordinate flow of information between medical clinic and referral authorization department to secure a valid referral for clinic patient.
• Enter referrals, documents communications and action into the system, as appropriate.
• Notify physician(s) and patient when referral is denied, or if additional information is needed.
• Develop and maintain database of referral physician offices preferred by each physician within the clinic.
• Conduct all functions associated with patient check-out including pricing services, collecting patient responsibility payments and scheduling follow-up appointments.
• Perform patient check-in at the time of visit and complete all paperwork necessary to ensure the admitting process is efficient and all clinic and regulatory policies are in compliance.
• Obtain accurate patient and insurance information, collecting copays (TOS) and deductible amounts.
• Copy/scan patient access related hardcopy materials (e.g. ID, referrals, insurance cards, etc.) into the correct location in the electronic medical record.
• Answer phone calls and direct them appropriately.
• Perform duties involving record filing and retrieval and assisting with the filing of registration documentation in electronic medical records.
• Assist Practice Manager with complaint resolution and solutions related to patient referrals.
• Perform other duties as assigned by the practice manager or physician.
  
  

Role Specific Behaviors

• Knowledge of clinic referral and scheduling processes and billing/authorization requirements.
• Knowledge of federal and state pay requirements, including Medicare, DSHS, HMO/PPO Contracts.
• Ability to communicate effectively and to maintain strict confidentiality.
• Ability to respond to people and issues promptly and appropriately, to resolve problems.
• A team player who handles multiple projects simultaneously in a fast paced environment.
• Possess a strong work ethic and a high level of professionalism.
  
  

Qualitifications

• High school diploma or equivalent preferred.
• Basic Life Support (BLS) for the Healthcare Provider certified or obtained within three (3) months of hire.
• Proof of completion of Mandatory Reporter abuse training specific to population served within three (3) months of hire.
  
  

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

00589695

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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