Referral & Insurance Specialist - St. Francis Physician Services

Bon Secours Mercy Health•Greenville, SC

12d

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 referral and testing eligibility and coverage, schedules appointments, informs patients about the referral process and provides instructions. It also supports billing operations by entering patient, insurance, charge, and demographic information; posting payments; balancing collections; and assisting patients with billing questions and account resolution. The specialist helps investigate billing problems and denials, supports coding and error resolution, coordinates with physician offices to obtain needed information, and may refer patients to the local Department of Social Services when appropriate. The role also provides front-office and records support, including answering phones, greeting and screening visitors, preparing encounter forms, maintaining charts, organizing records, coordinating patient movement, and distributing mail. The position promotes positive interpersonal and interdepartmental relationships.

Requirements

High school diploma or GED.
2–3 years of experience in a related medical field with experience processing referrals is preferred.

Nice To Haves

2–3 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 by phone, fax, or internet.
Schedule appointments for testing at medical facilities and appointments with physicians.
Notify patients in a timely manner whether referrals are authorized or denied, and provide instructions.
Investigate billing problems and denials.
Enter patient, insurance, demographic, charge, and correction information into billing systems.
Prepare daily patient charge encounter forms and update patient charts as needed.
Collect patient balances and copayments, balance money collected daily, and make daily deposits.
Post payments to the appropriate patient accounts.
Collect and reconcile daily physician charge slips and 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 and refer patients to the local DSS office when appropriate.
Answer phones, take messages, schedule appointments, greet patients, screen visitors, and respond to routine information requests.
Oversee the waiting area, coordinate patient movement, and report problems or irregularities.
Organize and file progress notes, testing reports, and other records; assist with filing patient charts.
Open and distribute daily mail as needed.
Promote positive interpersonal and interdepartmental relationships.