Outpatient Referral & Authorization Rep - Full Time

Position Title: Outpatient Referrals & Authorizations Rep      Position Code:         RpOPRAuth-8111 

Department: Outpatient Scheduling Center                             Safety Sensitive:    Yes            

Reports to: Outpatient Scheduling Manager                            Exempt Status:       No 

                                                                        

Position Purpose:

All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision to be among the kindest, highest quality health systems in the country.

This position is responsible for financially clearing all outpatient referrals as ordered by the referring provider. Financial clearing includes but not limited to, processing referral within provider EMR, verifying  insurance eligibility and benefits, contacting patients to discuss coverage, obtaining authorization when  necessary, maintains statistical information regarding payers, communicating with providers and staff of  denials, and documenting and scanning all communication into referral and EMR.  Provides guidance as needed to the department and provider office representatives when required.  Establish  and maintain inter-departmental communication within the hospital and work closely with the Medical Office.

Coordinators in the respect of issues that arise effecting orders. Other duties as assigned.

 

Key Responsibilities [List of material responsibilities and essentials duties which must be completed in achieving the objectives of the position]

 

 

Consistently demonstrates a willingness to assist co-workers in a courteous manner to support department efficiency. 

Develops and maintains good human relations skills by practicing AIDET, KRMC’s values, and behavioral standards with employees, patients, medical staff, and visitors in accordance with performance of duties.

Maintains positive attitude and functions as a team player.

Protects patient information and hospital financial reimbursement by inputting authorization information. 

Verifies the insurance and ensures that all notification/authorizations are completed in a timely manner as well as ensuring patient services are a covered benefit. 

Inputs notes pertinent to financial information to assist billing department in payment of the claim. 

Contacts responsible party of outpatient referral by telephone to advise of insurance coverage rate when insurance does not cover 100%; professionally advises responsible party of payment requirements and follows hospital policy in establishing payment arrangements or advises other referral sources. Contact is made before referral is sent to referring provider/department.

Meets productivity standards for working incoming referrals to schedule financially cleared outpatient visits in a timely manner.   

Referrals should be processed within three (3) business days.  Authorization should be initiated within three (3) business days.

Maintains statistical information regarding payers and communicates info routinely to Outpatient Scheduling Center Supervisor/Manager.

Assists with education to Outpatient Scheduling Reps.

Completes all assigned duties, and other duties as assigned, accurately and in a time

 

Qualifications [Statements regarding minimum educational and experience qualifications, required proficiencies with specialized knowledge, computer proficiencies, military service, required certifications, etc.] 

Education: High school graduate or equivalent required. 

Experience: Six months or more of progressive work experience required.  

 

Skills:

Ability to communicate effectively with others.

Manage multiple priorities and tasks.

Maintain attention to detail.

Knowledge of and ability to use computer hardware and software applications. 

 

 

Preferences [Preferred attributes for the position which are not absolutely required in the minimum qualifications (i.e., multi-lingual, master’s degree)]

Experience:  One-year hospital outpatient referrals and/or insurance verification experience preferred.

Skills:  Knowledge of medical terminology, coding rules and guidelines preferred.

 

Special Position Requirements [Optional section: any travel, security, risk, hazard, or related special conditions which apply to the position]

Bloodborne disease exposure category II:  Expected duties have possible, but not routine, potential for exposure to blood, body fluids or tissues. Other potential hazard(s):  Possible exposure to chemical substances and to hostile individuals.

 

Work Requirements [Optional section: work