LEAD REFERRAL SPECIALIST

UHS•Palmetto, FL

15d

About The Position

Position Summary: Responsible for scheduling referrals for patients, providers, pre-authorizing & pre-certifying tests/procedures. Scheduling of other tests with facilities at the request of providers and/or staff. Directly communicates with the clinics, referred to clinics, and patients. Reviews clinical data to report medical necessity to insurance companies. The lead is expected to solve problems and make decisions and take escalated calls to triage and manage as appropriate. Coordinates work schedules and absences of team members. Serves as a resource for other members of the team for technical or work challenges. Demonstrates and coaches exceptional patient interaction and following standard process for referral specialist. Assists the Operations Administrator in day-to-day operations to deliver the highest quality care to patients in an efficient manner. A Challenging and rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match About Universal Health Services (UHS), Inc. One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $13.4 billion in 2022. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 94,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Requirements

High school graduate or GED required.
Minimum of three-five years’ experience in a healthcare or clinical setting.
Knowledge of clinical terminology, insurance billing, procedural and diagnosis coding, federal and state insurance regulations and HIPAA privacy standards is strongly preferred.
Typing, ten key and computer skills required.
Proficiency in Microsoft Office applications required.
Required effective people skills and excellent written, oral communication skills required.
Patient Management, Billing and Managed Care system processes competency.
Understanding of functions and workflow of Clinical/Hospital departments.
Excellent planning and organizational skills.
Demonstration of strong analytical skills and problem-solving abilities.
Strong teamwork skills and the ability to effectively communicate with all management levels.
Results oriented, independently goal directed, able to multi-task and meet established time frames.

Nice To Haves

Acute healthcare knowledge and ability to evaluate clinical data to acquire pre-authorizations and referrals is preferred.
Knowledge of third-party reimbursement regulations is preferred.

Responsibilities

Responsible for scheduling referrals for patients, providers, pre-authorizing & pre-certifying tests/procedures.
Scheduling of other tests with facilities at the request of providers and/or staff.
Directly communicates with the clinics, referred to clinics, and patients.
Reviews clinical data to report medical necessity to insurance companies.
The lead is expected to solve problems and make decisions and take escalated calls to triage and manage as appropriate.
Coordinates work schedules and absences of team members.
Serves as a resource for other members of the team for technical or work challenges.
Demonstrates and coaches exceptional patient interaction and following standard process for referral specialist.
Assists the Operations Administrator in day-to-day operations to deliver the highest quality care to patients in an efficient manner.