Referral & Insurance Specialist - Rheumatology

Bon Secours Mercy Health • Greenville, SC

12d

About The Position

The Referral and Insurance Specialist obtains insurance authorizations for referrals to physicians or medical facilities, procedures, testing, and medications. The role verifies insurance eligibility and coverage, schedules appointments, and informs patients about referral decisions and instructions. It also supports patient billing and account resolution by entering charge, demographic, and insurance information; posting payments; balancing collections; investigating billing problems and denials; and working with physician offices to resolve coding errors or obtain needed information. The specialist also provides front-desk and medical-records support, including answering phones, greeting and screening visitors, preparing and updating charts, organizing records, and coordinating patient movement.

Requirements

• High school diploma or GED.
• Related medical-field experience processing referrals is preferred; 2–3 years is stated as preferred experience.

Nice To Haves

• 2–3 years of experience in a related medical field with experience processing referrals.

Responsibilities

• Obtain insurance or pharmacy benefit manager authorizations for referrals, procedures, testing, and medications.
• Verify eligibility and coverage for referrals and testing by phone, fax, or Internet.
• Schedule appointments with physicians and medical facilities for testing.
• Notify patients promptly whether referrals are authorized or denied and provide instructions.
• Investigate billing problems and denials, assist with coding and error resolution, and request needed information from physician offices.
• Enter and correct patient, insurance, demographic, charge, and other information in billing systems.
• Prepare patient charge encounter forms, collect daily charge slips, reconcile their number and totals, and enter charge information into the online billing system.
• Post payments to appropriate patient accounts, collect patient balances and copayments as needed, and balance money collected daily.
• Assist patients with billing questions and account balance resolution.
• Review information to determine an appropriate course of action for patients and refer them to the local DSS office when appropriate.
• Answer phones, take messages, schedule appointments, greet patients, screen visitors, and respond to routine information requests.
• Prepare or update patient charts, organize and file progress notes and testing reports, and assist with filing patient charts.
• Oversee the waiting area, coordinate patient movement, and report problems or irregularities.
• Open and distribute daily mail as needed.

Benefits

• Competitive pay and incentives.
• Referral bonuses.
• 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.
• Backup care for children and elders.
• Tuition assistance.
• Professional development and continuing education support. Benefits may vary based on market and employment status.

What This Job Offers

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