Specialist Senior, Patient Referral Management-3

We are recruiting for a motivated Specialist Senior, Patient Referral Management-3 to join our team!

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Department

Appointment Center

Job Summary

Under general supervision, Patient Referral Management agent serves customers by determining requirements, answering inquiries, resolving problems, fulfilling requests, and maintaining records. Responsible for patient referral processing, insurance authorizations, scheduling, liaises between insurance company and customer. Complete various administrative tasks to support our patients by sending referral documentation to our different departments that are internal and External. Work within a small team to organize, manage, and deliver referral documents on behalf of our patients. Possess excellent customer service and communication skills, cross-trained in all aspects of Call Center responsibilities and provides support to Management team.

Essential Functions:

• Responsible for processing/transcribing internal and external referrals via different modalities that include faxes and EHR. (20%)
• Resolves customer problems by clarifying issues, researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems. (5%)
• Fulfills requests by clarifying desired information; completing transactions; forwarding request. (5%)
• Maintain communications and collaborate with patient, provider, payer representative and staff. (5%)
• Gathers patient information by collecting demographic information from a variety of sources; enter and update patient information into Electronic Medical Records; maintains call center databases by entering information. (5%)
• Schedule of internal appointments according to preset scheduling guidelines. (5%)
• Maintains patient confidence by keeping patient records information confidential; delivers quality results by following organizational standards. (5%)
• Serves and protects the community by adhering to professional standards, organizational policies and procedures, federal state, and local requirements, and accreditation standards. (5%)
• Maintains continuity of work operations by documenting and communicating actions, irregularities and continuing needs; keeps equipment operation by following established procedures and reporting malfunctions. (5%)
• Enhances organization reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments. (5%)
• Familiarity with health insurance policies and procedures. (5%)
• Understand medical diagnosis to discuss with health insurance companies and to determine why a patient must be referred. (5%)
• Understands standardized scheduling, rescheduling, and cancellation guidelines. Schedules to appropriate provider according to patient request, provider direction, and availability. (5%)
• Update job knowledge by participating in educational opportunities. (5%)
• Proficient in verification and updating demographic, financial, guarantor, insurance and patient information for new and existing patients within the practice management/electronic health record and various Denver Health computer applications. (5%)
• Determines requirements by working with internal and external customers; answers inquiries by clarifying desired information. (5%)
• Other Duties as assigned. (5%)

Education:

• High School Diploma or GED Required
• Associate's Degree Two years of College or Associate's Degree Preferred

Work Experience:

• 4-6 years Three to five years in a hospital/medical office setting preferred or relevant experience in a customer service business with the ability to relate to a diverse patient population. Required and
• 4-6 years Familiar with a variety of healthcare concepts, practices, and procedures. Required

Licenses:

Knowledge, Skills and Abilities:

• Ability to prioritize and perform a multitude of duties with great attention to detail and a high level of accuracy in a fast paced environment relying on extensive experience and judgment to plan and accomplish goals.
• Knowledge of Commercial Insurance referral and authorization process is preferred.
• Knowledge of medical terminology and benefits.
• Excellent customer focus/service, people skills, listening, verbal and written communi