Referral Specialist - Orthopedics

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Job Summary

To provide our patients a seamless entry in to the Prisma Health experience. The Referral Specialist interfaces with patients and physician office team members to accurately authorize various consultations, procedures and tests. The Referral Specialist utilizes each patient’s preferred method of contact. The Referral Specialist utilizes various electronic medical records to transmit required clinical documentation to third party payors and Specialist Physicians. Responsibilities include documenting all actions and encounters regarding the referral including timely follow up with the patient, referring and referral physician practice and third party payors including pre-certification, cancelled and rescheduled appointments, and other events preventing closure of the referral experience.

Accountabilities

• Responsible for the authorization/precertification process to include coordinating with outside and internal organizations along with insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis and prognosis. Provides specific medical information to financial services to maximize reimbursement to the hospital and physicians.

• Accurately records demographic, coverage, and scheduling information in various systems. Reminds patients of scheduled appointments via mail, internet, or telephone. Ensures that patient’s primary care chart is up to date with scheduling information about specialist consults, tests, and procedures managed. Alerts management to trends in appointment availability and appointment date timeliness.

• Promotes hospital goals towards meaningful use in the electronic medical record on behalf of the referring physician. Documents referral status and all scheduled appointments in appropriate system (electronic medical record) for referral tracking data. Responsible for following up after patient’s consultation, procedure, and/or test to determine if physician has received report; continues to check on status until complete.

• Serves as Liaison between the provider, practice, patient and specialist providing the service.  Communicates Provides appropriate patient clinical information and referral needs to specialist office.
• Verifies physician’s orders to ensure the accuracy of results and communicates with the patient the guidelines, protocols and location.

• Assists patients in problem solving potential issues related to navigating the health care system, financial obligations or social barriers (e.g., request interpreters if appropriate, transportation services or prescription assistance). May assume advocate role on the patient’s behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.

• Promptly responds to patient’s scheduling requirements (date and time), questions and concerns to ensure patient experience expectations are met or exceeded.   Ensures timely appointments are booked; reviews details and expectations about the referral process with patients.

• Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by Palmetto Health.

• To ensure the effective and efficient operation of the facility and to create an extraordinary patient, physician and team member experience.

• Performs other duties as assigned.

Supervisory/Management ResponsibilitiesThis is a non-management job that will report to a supervisor, manager, director or executive.Minimum EducationHigh School diploma or equivalentMinimum Experience

Two (2) years of comparable experience, preferably in a physician front office to include patient registration and/or electronic scheduling and the authorization/precertification process.

Other Required Experience

Must have excellent customer service skills and a sincere desire to make every patient and their family feel safe, welcomed and appreciated.  Excellent oral and written communication skills and interpersonal phone skills. Knowledge of various health insurance companies.  Knowledge of medical terminology, CPT and Diagnosis Coding, insurance verification and updates, and the authorization/precertification process. Knowledge of Microsoft office products. Must pass data entry test 85 kst. with 90% accuracy. 

Work Shift

Day (United States of America)

Location

2 Medical Park Rd Richland<