Referral Specialist
Referral Specialist
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Salary Not Disclosed
1 Vacancy
Job Description
Overview
CHI Memorial Urology Associates Holtzclaw
CHI Memorial Hospital now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI) and Dignity Health is once again the only hospital in the Chattanooga area to be named a Best Regional Hospital by U.S. News & World Report. We are proud to be the regional referral center of choice providing health care throughout Southeast Tennessee and North Georgia.
We care about our employees well-being and offer benefits that complement work/life balance.
We offer the following benefits to support you and your family:
Free Membership to our program supporting any child care pet care or adult dependent needs
Employee Assistance Program (EAP) for you and your family
Health/Dental/Vision Insurance
Flexible spending accounts
Voluntary Protection: Group Accident Critical Illness and Identity Theft
Adoption Assistance
Paid Time Off (PTO)
Tuition Assistance for career growth and development
Matching Retirement Programs
Wellness Program
If you are passionate about the patient experience and ready to join our nationally recognized hospital connect with us today!
Responsibilities
The Referral Specialist works with patients requiring a referral for a test or to a specialist office to ensure patients referral needs are fulfilled for tests and specialty service office visits. Processes orders for tests and referrals authorizations and pre-certifications for patients to ensure timely reimbursements. Follows up on all test and referrals to specialist office until the documentation is received and scanned into the system for reconciliation.
Essential Key Job Responsibilities
- Gather verify and process orders for test 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.
- Communicates or gives written material to patients with referral information such as date time and location as well as contact information to ensure patient has resources to review if needed.
- Coordinate flow of information between medical clinic and patients insurance for referral authorization to secure a valid referral for clinic patient.
- Enter and annotate testing information and referrals does e-referral for applicable practices for meaningful use and follows-up to make sure e-referral and or faxed referrals are received documents communications and action into PPMS and AEHR as appropriate.
- Maintains supply of contrasting prep for testing so that when patients are scheduled the prep can be given to the patient and the patient can be educated as to the prep. Otherwise patients are told to be at the testing site 1 hours early for prep.
- Notify physician(s) and patient when test or referral is denied or if additional information is needed.
- Develop and maintain database of referral physician offices preferred by each physician within the clinic.
- Maintains complaint resolution and solutions related to patient referrals. Calls or faxes for test and referral documents documents in notes when attempts are made to reconcile the test or referral. Scans the documents into the system and closes the order or referral. Documents all test and referrals in PPMS and AEHR for outmigration reporting.
- Knowledge of clinic referral and scheduling processes and billing/authorization requirements.
- Knowledge of federal and state pay requirements including Medicare DSHS HMO/PPO Contracts.
Qualifications
Education:
- High school diploma or equivalent required.
Qualifications:
- 2 years of progressively responsible related experience in a healthcare office environment specializing in the referral process is preferred.
- Experience in AEHR and PPMS systems is preferred
Required Experience:
Unclear Seniority
Employment Type
Unclear
