Referral Specialist, FT, Days

About the role

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 and various electronic medical records to transmit required clinical documentation to third party payors and Specialist Physicians. Documents 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.

Responsibilities

• Coordinate with outside and internal organizations along with insurance companies to ensure prior approval requirements are met.
• Present necessary medical information such as history, diagnosis and prognosis to payors.
• Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians.
• Record demographic, coverage, and scheduling information in various systems.
• Remind patients of scheduled appointments via mail, internet, or telephone.
• Ensure that patient’s primary care chart is up to date with scheduling information about specialist consults, tests, and procedures managed.
• Alert management to trends in appointment availability and appointment date timeliness.
• Promote hospital goals towards meaningful use in the electronic medical record on behalf of the referring physician.
• Document referral status and all scheduled appointments in appropriate system for referral tracking data.
• Follow up after patient’s consultation, procedure, and/or test to determine if physician has received report; continue to check on status until complete.
• Serve as liaison between the provider, practice, patient and specialist providing the service.
• Provide appropriate patient clinical information and referral needs to specialist office.
• Verify physician’s orders to ensure the accuracy of results and communicate with the patient the guidelines, protocols and location.
• Assist 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).
• 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.
• Respond to patient’s scheduling requirements (date and time), questions and concerns to ensure patient experience expectations are met or exceeded.
• Ensure timely appointments are booked, review details and expectations about the referral process with patients.
• Maintain patient confidentiality; comply with HIPAA and compliance guidelines established by Prisma Health.
• Ensure the effective and efficient operation of the facility and to create an extraordinary patient, physician and team member experience.

Minimum Experience and Education

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

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.