Patient Access-Referral Specialist

Rivers Health is seeking a Full-Time Referral Specialist  to perform the following duties:

 

The following is a summary of the essential functions of this job.  The

incumbent may perform other duties, both major and minor, that are not

mentioned below; and specific functions may change from time to time.

 

1. Verifies and documents correctly insurance coverage for all

     Radiology exams requiring prior authorization.

    

1. Contacts insurance companies to obtain prior authorizations for

     ancillary exams prior to scheduling exam/service.  Confirms in-

     network and insurance benefits prior to scheduling.

    

1. Must have knowledge and understanding of CPT4 and ICD9 coding.

    

1. Verifies medical necessity for all ancillary exams requiring prior

     authorizations.

 

1. Verifies and documents benefits for coverage for all ancillary exams

     requiring prior authorizations.

 

1. Once authorization is obtained, contacts central scheduling office

     for appointment date and time.

 

1. Promotes a positive image of Physician Practice Services and

     Rivers Health to all patients and public.

 

1. Follows departmental and hospital policies and procedures as

     required.

 

1. Demonstrates excellence in customer service skills.

 

1. Fosters an atmosphere of teamwork and collaboration.

 

1. Participates in quality improvement activities including serving on

     quality improvement teams.

 

1. Other duties may be assigned.

 

1. Complies with Corporate Policies, Departmental Policies and

     Procedures and Personnel Handbook.

 

1. Will coordinate patient payment with the financial counselor.

Qualifications

QUALIFICATIONS:

 

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this position.

 

 

EDUCATION AND FORMAL TRAINING:

 

High school diploma or equivalent required.  Associate degree or graduate

of approved program for Medical Assistant (or associate degree in related field) or experience in Physician's Practice preferred. 

 

 

WORK EXPERIENCE:

 

Previous experience in physician's office or other healthcare field

preferred.  Prior authorization experience highly desirable.

 

 

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

 

Must have a good understanding of physician's office procedures.  Must have demonstrated ability to work with the public.  Proficiency in medical techniques and general business practices required for the treatment of patients in a physician office setting.  Needs to have good communication and interpersonal skills.  Must demonstrate the ability to effectively communicate with and understand patients.  Must be able to cope with highly stressful situations and set priorities for multiple tasks. 

 

 

STANDARDS OF PERFORMANCE:

 

Rivers Health is committed to providing excellent

service to our customers.  Each and every interaction with your

customers become an opportunity to serve.  Every employee is

accountable for delivering an excellent customer experience.