Referral & Insurance Specialist - Pain Management

Bon Secours Mercy Health • Paducah, KY

5d

About The Position

The Referral and Insurance Specialist obtains insurance authorizations for referrals to physicians and medical facilities, procedures, testing, and medications. The specialist verifies eligibility and coverage through phone, fax, or the Internet; schedules appointments; and provides patients with timely updates and instructions about the referral process, including authorization decisions.

The role supports billing and patient account operations by gathering and entering charge, demographic, and insurance information; posting payments; balancing collected funds; and helping patients resolve billing questions and account balances. The specialist also assists with coding and error resolution, maintains patient charts and related records, manages routine reception and telephone duties, and helps coordinate patient flow. Other duties may be assigned by a supervisor, subject to reasonable accommodation.

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 insurance authorizations for referrals to physicians and medical facilities, procedures, testing, and medications.
• Verify eligibility and coverage for referrals and testing through phone, fax, or the Internet.
• Schedule appointments for testing at medical facilities and appointments with physicians.
• Notify patients promptly about referral authorization or denial and provide instructions.
• Investigate billing problems and denials.
• Enter patient, insurance, demographic, and charge information into computer and online billing systems; update or correct records as needed.
• Prepare patient charge encounter forms and collect daily charge slips from physicians, reconciling their number and totals.
• Post payments to appropriate patient accounts and make daily deposits; balance money collected each day.
• Collect patient responsibility balances and copayments as needed.
• Assist patients with billing questions and account balance resolution.
• Assist with coding and error resolution and request needed information by working with physician offices.
• Review information to determine an appropriate course of action for patients and refer them to the local DSS office when appropriate.
• Answer telephone calls, take messages, schedule appointments, greet patients, and screen visitors.
• Prepare and update patient charts; organize and file progress notes, testing reports, and other documents needed for chart completion.
• Oversee the waiting area, coordinate patient movement, and report problems or irregularities.
• Open and distribute daily mail as needed.
• Promote positive interpersonal and interdepartmental relationships.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED