Referrals Representative

POSITION SUMMARY

The Referral Representative is responsible for processing patient referrals. Educates the patients on various procedures and benefits, related to the need for referrals. Coordinates referrals with patients and specialist's offices, and process insurance referrals as required.  Acts as a liaison between patient, physician, and insurance company, consistently performing activities in a friendly, courteous, and professional manner.  Assists patients over the phone using the call center representative standards. 

EXPECTATIONS

Every Adelante Healthcare employee will strive to maximize their performance and contribution to Adelante Healthcare and the community we serve every day.  Employees are expected to work in a manner that demonstrates a commitment to quality, patient safety, employee engagement, innovation, and the highest standards of personal integrity, professionalism, and competence.

OUR CORE VALUES

• Compassion
• Excellence
• Integrity
• Learning
• Respect
• Sustainability

ESSENTIAL SKILLS AND EXPERIENCE:

• Excellent verbal and written communication skills and having a professional presence
• Ability to communicate effectively with patients, co-workers, and the public both in person and over the phone

• One (1) to two (2) year of medical referral experience and one (1) to two (2) years of customer service experience.
• Basic knowledge of medical terminology.
• Accuracy and attentional to detail
• Ability to prioritize and perform multiple tasks simultaneously
• Must possess strong organization skills
• Be able to work independently and within a team
• MS Office: Particularly Excel, Word, and Outlook
• Computerized database experience
• Office skills: typing, faxing, scanning and telephone
• High school diploma or GED from an accredited institution
• Commitment to Adelante Healthcare’s mission, vision, and values
• Willingness to be cross-trained and learn new skills and responsibilities

• Valid Level One Fingerprint Clearance Card issued by the Arizona Department of Public Safety for all specialty behavioral health locations

POSITION REPONSIBILITIES

• Initiate and manage clinical referrals for pre-authorization
• Act as a liaison between health plans, physicians, patients, and other referral sources
• Review referrals for completeness and follows up for additional information if necessary
• Respond to inbound calls initiating exam requests following established processes, meeting quality and production standards
• Contact physician offices as needed to obtain demographic information or related data
• Enter referrals, referral denials, insurance authorizations, documents communications and actions into patient account history.
• Schedule patient initial and follow up appointments ensuring efficient use of provider time and the appropriate care for patients
• Perform patient pre-registration including accessing and updating patient information as indicated
• Follow established procedures for answering and screening incoming appointment-related telephone calls, scheduling interpreters, and directing calls to appropriate staff
• Attend staff meetings, in-service meetings, or other required meetings
• Maintain satisfactory attendance, is punctual and works full scheduled shift
• Meeting minimum standards of metric expectations

NONESSENTIAL SKILLS AND EXPERIENCE: