Referral & Insurance Specialist - Rheumatology

Bon Secours Mercy Health • Greenville, SC

14d

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 eligibility and coverage, schedules appointments, enters patient, insurance, and charge information into billing systems, posts payments, and makes daily deposits. The specialist also assists patients with billing questions and account resolution and promotes positive interpersonal and interdepartmental relationships.

The position supports patient flow and medical record completion by answering phones, greeting and screening visitors, coordinating appointments and patient movement, preparing charge encounter forms, updating charts, and organizing and filing notes and reports. It investigates billing problems and denials, communicates referral outcomes and instructions to patients, reconciles daily charge slips, and works with physician offices to resolve coding errors or obtain missing information. When appropriate, the specialist reviews patient information and refers patients to the local DSS office.

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.
• Obtain authorizations from insurance carriers or pharmacy benefit managers for 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.
• 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 maintain accurate billing-system information.
• Answer telephones, 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 forms 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 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 refer them 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.

What This Job Offers

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