Referrals Coordinator

Jersey Community Hospital; Jerseyville (IL); On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Retirement

Paid Time Off

Tuition Reimbursement

Health Savings Account

Wellness Program

Employee Assistance Program

Job summary

Jersey Community Hospital in Jerseyville, IL seeks a detail-oriented professional to manage patient prior authorizations and referrals. You will schedule internal and outgoing referrals, verify insurance coverage, and document status for efficient workflow.

You will interact with patients and insurers to discuss coverage, benefits, and required preauthorizations, while maintaining accurate records and responding to changing priorities.

Qualifications

• Excellent communication and interpersonal skills necessary to discuss financial matters with patients and providers.
• Ability to explain insurance benefits to patients and representatives clearly.
• Capable of navigating complex information and payor requirements.

Responsibilities

• Responsible for patient prior authorization and referrals including scheduling internal and outgoing referrals.
• Document status of prior authorizations and referrals and monitor work queues.
• Verify insurance coverage and day-to-day management of authorization/referral processes.
• Communicate with patients and insurance companies about coverage and requirements.
• Notify patients of preauthorization, financial clearance, and physician order requirements.
• Perform additional duties as assigned.

Skills

Communication

Interpersonal skills

Insurance knowledge

Attention to detail

Adaptability

Education

High school diploma

Job description

Description

Summary:

Responsible for patient prior authorization, patient referrals including scheduling of internal referral and outgoing patient referrals, documentation of status of prior authorizations and referrals, ability to navigate registration, referral entries, auth/cert entries, ability to update and confirm current patient insurance coverage and day to day monitoring of all prior authorizations and referrals work queues

• Communicates with patients and insurance companies regarding coverage and other related matters.
• Discusses benefits with patients, responds to patient/third party inquiries.
• Completes insurance verification /pre-certification according to payor requirements: Identifies outpatient procedures that require precertification /second opinion: obtains required information from physician; pre-certifies inpatient admissions.
• Conducts physician office/patient interviews and explains hospital procedure guidelines and policies
• Provides the patient with prep and other appointment instructions
• Follows guidelines for special requires /STAT/schedule modification procedures and coordinates communications with clinical areas to accommodate the patient requests
• Notifies patient of physician order, preauthorization and other financial clearance requirements.
• Other roles and responsibilities as assigned.

Requirements

Education/Experience:

• High school graduate or equivalent
• Prior medical experience and knowledge of insurance policies and procedures preferred
• Medical terminology knowledge preferred

Skill/Abilities:

• Excellent communication and interpersonal skills required to discuss financial matters with patients and/or their representative, and to work with all levels of professionals at JCH and in other organizations
• Ability to comprehend large amounts of complex information, and explain complex insurance benefits to patients and/or their representatives
• Ability to respond to quickly changing priorities and patient needs
• Demonstrated computer skills and relates experience preferred

Physical Requirements:

• Work is of light demand
• Motor coordination and finger dexterity required to operate computer equipment and other office machines

Benefits:

• Health Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Retirement
• Paid Time Off
• Tuition Reimbursement
• Health Savings Account
• Wellness Program
• Employee Assistance Program