Referral and Insurance Specialist - Physician Practice - Tuckahoe Orthopaedic & Physical Therapy - Mechanicsville
About The Position
The Referral and Insurance Specialist obtains insurance authorizations for referrals, medications, procedures, and testing; verifies eligibility and coverage; and schedules appointments with physicians and medical facilities. The role also supports physician-practice billing and front-office operations, including entering patient, insurance, and charge information, posting payments, balancing collections, and assisting patients with billing questions and account resolution. The specialist helps maintain accurate patient charts and records, coordinates patient movement, and promotes positive relationships with patients and colleagues.
Requirements
- High school diploma or GED.
- Licensure or certification is not required.
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, medications, procedures, and testing.
- Verify insurance eligibility and coverage for referrals and testing by phone, fax, or internet.
- Schedule appointments for testing at medical facilities and appointments with physicians.
- Investigate billing problems and denials.
- Notify patients promptly about the referral process and authorization decisions, and provide instructions.
- Enter patient and insurance changes or corrections to keep billing-system information accurate and current.
- Answer telephone calls, take messages, schedule appointments, and greet patients as needed.
- Prepare daily patient charge encounter forms and create or update patient charts 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.
- Collect patient balances and copayments as needed and balance collected money daily.
- Open and distribute daily mail as needed.
- Collect daily physician charge slips and reconcile their number and totals.
- Post payments to the appropriate patient accounts in the computer billing system.
- Enter charge information into the online billing system.
- Assist with coding and error resolution and request needed information from physician offices.
- Help patients resolve billing questions and account issues.
- Review information to determine an appropriate course of action for patients and make referrals to the local DSS office when appropriate.
Benefits
- Competitive pay, incentives, referral bonuses, and a 403(b) with employer contributions when eligible.
- Medical, dental, vision, and prescription coverage; HSA/FSA options; life insurance; mental health resources; and discounts.
- Paid time off, parental and FMLA leave, short- and long-term disability, and backup care for children and elders.
- Tuition assistance, professional development, and continuing education support.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
