Patient Referral Representative - Ortho

Nevada System of Higher Education•Woodridge, IL

2d•$20 - $29•Onsite

About The Position

The Patient Referral Representative - Ortho is responsible for reviewing provider orders and/or requests for patient services, determining the appropriate referral, prior authorizations, and pre-certifications process per health plan requirements. This role involves consistently providing the highest level of customer service both on the phone and in person. The representative will review open status referral reports/Epic work queues daily and process referrals to approved, closed, or incomplete status based on established policy. They will ensure complete and accurate registration, including patient demographic and current insurance information, and address patient questions and concerns regarding their referrals, setting clear guidelines and expectations about the EHV referrals process. The position requires utilizing online tools to research criteria for verifying insurance coverage and the need for preauthorization, and communicating professionally with insurance companies, patients, primary care physicians, specialists, and/or facilities regarding authorization as needed. The representative will work with the provider to ensure the procedure has correct coding and is approved prior to initiation of the procedure/test/treatment. Establishing and maintaining good working relationships with hospital departments, health plan representatives, and physician office personnel is crucial for timely information transfer to complete the authorization process and promote goodwill. All referral information must be documented in Epic, and strict confidentiality of all health records and member information must be maintained, meeting HIPAA guidelines.

Requirements

High School Diploma or GED
Minimum of two years of physician office or physician billing experience
Minimum of one year of customer service experience
Working knowledge of medical terminology or coding experience
Proficient keyboard and computer skills

Responsibilities

Reviewing provider orders and/or requesting for patient services and determining appropriate referral, prior authorizations, and pre-certifications process per health plan requirements.
Consistently providing the highest level of customer service both on the phone and in person.
Reviews open status referral report/Epic work queues daily and processes referrals to approved, closed or incomplete status based on established policy.
Ensures complete and accurate registration, including patient demographic and current insurance information.
Addresses questions and concerns with patients regarding their referrals and sets guidelines and expectations about the EHV referrals process.
Utilizes online tools to research criteria to verify insurance coverage and need for preauthorization.
Communicates professionally with insurance companies, patients, primary care physicians, specialists and/or facilities regarding authorization as needed.
Works with the provider to ensure the procedure has correct coding and is approved prior to initiation of procedure/test/treatment.
Establishes, develops and maintains good working relationships with hospital departments, health plan representatives and physician office personnel to ensure timely transfer of information to complete the authorization process and promote goodwill.
Documents all referral information in Epic.
Ensures strict confidentiality of all health records, member information and meets HIPAA guidelines.