Referral Center Representative

UnityPoint Clinic

Referral Center Representative

Monday-Friday 8 HR shift between 7:00AM-6:00PM OR 4 day 10 HR shift between 7:00AM-6:00PM

Full Time Benefits

At UnityPoint Health you matter. Were proud to be recognized as a Top 150 Place to Work in Healthcare by Beckers Healthcare several years in a row for our commitment to our team members.

Our competitive Total Rewards program offers benefits options that align with your needs and priorities no matter what life stage youre in. Here are just a few:

• Expect paid time off parental leave 401K matching and an employee recognition program.

• Dental and health insurance paid holidays short and long-term disability and more. We even offer pet insurance for your four-legged family members.

• Early access to earned wages with Daily Pay tuition reimbursement to help further your career and adoption assistance to help you grow your family.

With a collective goal to champion a culture of belonging where everyone feels valued and respected we honor the ways people are unique and embrace what brings us together.

And we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience.

Find a fulfilling career and make a difference with UnityPoint Health.

The Referral Center Representative is responsible for coordinating patient referrals scheduling specialty exams obtaining insurance pre-authorizations and ensuring accurate documentation to ensure timely and accurate healthcare access. The role acts as a liaison between patients healthcare providers and third-party payers to facilitate seamless communication and care coordination. The role also supports administrative tasks maintains compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations and enhances workflow efficiencies through referral tracking and quality improvement initiatives.

Referral Coordination & Care Support
Works on patient referrals by coordinating appointment scheduling and ensuring the timely and accurate processing of referral requests initiating referrals within 24 hours on business days and documenting all stages in Electronic Medical Records (EMR) systems.
Coordinates and schedules specialty exams diagnostic tests and outpatient services as needed ensuring proper authorization and documentation.
Obtains and documents insurance pre-authorizations and approvals from Third-Party Payers (TPP) for services as required.
Tracks and monitors referrals ensuring proper documentation and follow-ups for injury cases and maintains accurate referral reports for management.
Acts as a liaison between patients providers employers insurance companies attorneys and healthcare facilities to ensure seamless communication care coordination and timely notification of appointments and procedure instructions.
Administrative & Compliance Support
Monitors and distributes incoming faxes voicemails and messages forwarding them to appropriate personnel as required.
Completes necessary forms and requisitions for referrals and diagnostic testing ensuring accurate Current Procedural Terminology (CPT) / International Classification of Diseases 10th Revision (ICD-10) coding for billing and insurance purposes.
Maintains current knowledge of payer-specific prior authorization requirements attending virtual workshops and reviewing updates from insurance providers.
Registers patients verifies demographic and insurance information and assists scheduling of office staff to optimize patient flow.
Supports quality improvement initiatives by tracking referral trends identifying delays and implementing workflow optimizations.
Ensures adherence to the Health Insurance Portability and Accountability Act (HIPAA) regulations maintaining patient confidentiality while handling sensitive information.

Education

HS Diploma

Knowledge Skills Abilities and Other

Administrative Support

Ability to provide general administrative support including scheduling maintaining departmental records and coordinating team activities.
Patient Registration & Scheduling

Proficiency in assisting patients with check-in check-out appointment scheduling and follow-ups while ensuring accuracy and efficiency.
Medical Terminology & Coding Knowledge

Understanding of International Classification of Diseases (ICD)-9/10 Current Procedural Terminology (CPT) coding anatomy physiology and disease processes to support referral documentation and insurance processing.
Medical Billing & Insurance Procedures

Basic knowledge of medical billing insurance documentation and reimbursement processes.
Regulatory & Compliance

Knowledge of Healthcare laws and patient rights including HIPAA and informed consent safety standards and emergency protocols.
Office Software Proficiency

Knowledge of office software (e.g. Microsoft Office Suite) and hospital management software (if applicable).
Document Management Systems

Knowledge of record-keeping and filing systems both physical and electronic to ensure compliance with industry standards.
Organizational Skills

Strong ability to manage multiple tasks schedules and priorities in a fast-paced environment.
Customer Service

Ability to interact effectively with internal staff external partners and customers handling inquiries and aiding as needed.
Critical Thinking

Ability to quickly assess situations prioritize needs and resolve issues efficiently.