Referral & Insurance Specialist - St. Francis Physician Services

Bon Secours Mercy Health•Greenville, SC

13d

About The Position

The Referral and Insurance Specialist obtains insurance authorizations for referrals to physicians and medical facilities, procedures, testing, and medications. The role verifies insurance eligibility and coverage, schedules appointments, and communicates referral decisions and instructions to patients. It also supports billing operations by entering patient, insurance, and charge information; posting payments; reconciling charge slips and daily collections; and investigating billing issues and denials. The specialist assists patients with billing questions and account resolution, coordinates with physician offices to resolve coding and information errors, and may refer patients to the local DSS office when appropriate. The role also provides patient-facing and administrative support, including answering phones, greeting and screening visitors, scheduling appointments, maintaining charts and records, coordinating patient flow, and distributing mail. The position promotes positive interpersonal and interdepartmental relationships.

Requirements

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

Nice To Haves

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

Responsibilities

Obtain authorizations from insurance companies for referrals to physicians or medical facilities and for procedures or testing.
Schedule appointments for testing at medical facilities and appointments with physicians.
Verify eligibility and coverage for referrals and testing by phone, fax, or Internet.
Investigate billing problems and denials.
Notify patients promptly whether referrals are authorized or denied and provide instructions.
Enter patient and insurance changes or corrections to keep billing information current and accurate.
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 responsibility balances and copayments as needed, and balance money collected daily.
Open and distribute daily mail as needed.
Obtain authorizations from insurance carriers or pharmacy benefit managers for medications.
Collect daily physician charge slips and reconcile their number and totals.
Post payments to the appropriate patient accounts in the computer billing systems.
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 balances.
Review information to determine an appropriate course of action for patients and make referrals to the local DSS office when appropriate.