Central Insurance Referral Specialist II - UPMC Central Referrals (Part-Time)

UPMC•Harrisburg, PA

4d•Onsite

About The Position

UPMC is hiring a part-time Central Insurance Referral Specialist II to support its office in Harrisburg. The team is currently located in Lemoyne and will soon move to a new office location in Harrisburg. The position is 20 hours per week, working four hours per day Monday through Friday during day-shift hours, with no weekends or holidays. The Insurance Specialist II coordinates referrals and authorizations across outpatient practices. The role manages specialty referrals, coordinates diagnostic testing, obtains insurance referrals and prior authorizations, and secures pre-certifications as required by insurance carriers. It also educates patients about referral requirements, insurance benefits, and practice policies. As a liaison among patients, providers, specialty offices, and insurance companies, the specialist facilitates timely communication and coordination of care while maintaining a friendly, courteous, and professional approach. The role manages referrals and authorizations for more than three specialty areas across multiple geographic locations, requiring strong organization, attention to detail, and the ability to manage complex workflows in a fast-paced environment.

Requirements

High school graduate or equivalent.
At least 2 years of experience in a physician's office or outpatient facility.
Knowledge of electronic medical records and electronic health information systems.
Knowledge of insurance companies, guidelines and requirements, authorization and referral processes, and insurance websites.
Knowledge of medical terminology, anatomy, disease processes, CPT and ICD-9 coding, and managed care policies and procedures.
Familiarity with Windows software, Word, Excel, and Outlook.
Strong organizational and communication skills, and the ability to work independently and as part of a team.
Act 34 clearance.

Responsibilities

Interact with physicians, physician extenders, and fellow employees in a courteous and professional manner.
Explain policies and procedures, answer questions, and provide age-specific instructions to patients and family members.
Be attentive to individual needs, receptive to questions and criticism, and willing to offer assistance.
Protect each person's legal and moral right to confidentiality.
Perform other duties as assigned by the manager.
Use electronic referral and authorization services when available.
Communicate with insurance offices to authorize services.
Accept referral requests from patients, specialists, and primary care offices.
Answer telephone calls promptly and professionally.
Handle insurance appeal requests when necessary.
Coordinate out-of-network exceptions with insurance companies when necessary.
Provide necessary patient medical information to insurance companies upon request.
Obtain insurance authorizations for diagnostic testing.
Schedule appointments accurately and follow all scheduling criteria.
Transcribe Epic orders as indicated by the ordering provider.
Handle urgent and ASAP appointment requests promptly.
Maintain a referral log and document all referrals in the patient medical record.
Maintain an up-to-date listing of network providers.
Complete insurance referrals for patients' scheduled appointments.
Monitor referrals to help patients stay within network and coordinate with insurance companies to return patients to the network when needed.
Coordinate diagnostic testing appointments, advise patients about test preparation when applicable, and obtain insurance authorization when applicable.
Send appointment requests and appropriate patient records to specialists, and process insurance referrals when applicable.
Coordinate appointments with specialist offices both locally and outside the local area.
Attend insurer-provided meetings and training sessions.
Handle patient inquiries about referrals and authorizations.
Keep referral and authorization guidelines and insurance company requirements up to date.
Educate and assist providers in selecting appropriate diagnostic test orders based on current radiology guidelines.
Educate members, providers, and office staff about insurance guidelines and requirements related to referrals and authorizations.