Referral and Insurance Specialist - Physician Practice - Tuckahoe Orthopaedic & Physical Therapy - Mechanicsville

Bon Secours Mercy Health•Mechanicsville, VA

About The Position

The Referral and Insurance Specialist works in a physician practice to obtain insurance authorizations for referrals, procedures, testing, and medications; verify coverage; and arrange appointments with physicians and medical facilities. The role also supports patient billing and account resolution by gathering and entering charge and demographic information, posting payments, balancing daily collections, investigating billing problems and denials, and helping patients understand their accounts. The specialist assists with front-office and medical-record workflows, including answering phones, scheduling appointments, greeting and screening visitors, preparing encounter forms, updating charts, organizing records, coordinating patient movement, and distributing mail. The position promotes positive relationships with patients and colleagues and may refer patients to local DSS offices when appropriate.

Requirements

High school diploma or GED.
Two to three years of experience in a related medical field, with experience processing referrals, preferred.

Nice To Haves

Two to three years of experience in a related medical field, including experience processing referrals.

Responsibilities

Obtain authorizations from insurance companies or pharmacy benefit managers for referrals, procedures, testing, and medications.
Verify patient eligibility and coverage for referrals and testing by phone, fax, or internet.
Schedule appointments for physicians and testing at medical facilities.
Investigate billing problems and denials, assist with coding and error resolution, and work with physician offices to obtain needed information.
Notify patients promptly about whether referrals are authorized or denied and provide patient instructions.
Enter and update patient, insurance, demographic, and charge information in the billing system.
Prepare daily patient charge encounter forms and update patient charts as needed.
Collect patient balances and copayments, post payments to the correct accounts, balance daily collections, and make deposits.
Assist patients with billing questions and resolving account balances.
Answer telephones, take messages, schedule appointments, and greet patients as needed.
Oversee the waiting area, coordinate patient movement, and report problems or irregularities.
Screen visitors and respond to routine requests for information.
Organize and file progress notes, testing reports, and other records needed to complete charts; assist with filing patient charts.
Open and distribute daily mail as needed.
Review patient information to determine an appropriate course of action and make referrals to local DSS offices when appropriate.