Referral & Insurance Specialist - Pain Management

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 insurance eligibility and coverage, schedules appointments, and communicates the referral process and instructions to patients. The role also supports billing operations by entering patient, insurance, and charge information; applying payments; collecting copayments and patient balances; investigating billing problems and denials; and helping resolve account questions. Additional duties include answering phones, greeting and assisting patients, maintaining charts and records, coordinating patient flow, and supporting positive relationships with patients and colleagues.

The position is in Mercy Pain Management at the Marshall Nemer Pavilion. A high school diploma or GED is required. Related medical-field experience, including referral processing, is preferred. No licensure or certification is required.

Requirements

• High school diploma or GED.
• The posting lists no licensure or certification requirement.

Nice To Haves

• Two to three years of experience in a related medical field, including experience processing referrals.

Responsibilities

• Obtain authorizations from insurance companies, carriers, and pharmacy benefit managers for referrals, procedures, testing, and medications.
• Verify insurance eligibility and coverage for referrals and testing by phone, fax, or internet.
• Schedule appointments with physicians and medical facilities for testing.
• Notify patients in a timely manner 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 update patient demographic, insurance, and charge information in billing systems.
• Prepare daily patient charge encounter forms and create or update patient charts as needed.
• Collect patient balances and copayments, balance collected money daily, and apply payments to the appropriate patient accounts.
• Collect and reconcile physicians’ daily charge slips and enter charge information into the online billing system.
• Assist patients with billing questions and account balance resolution.
• Answer telephone calls, take messages, schedule appointments, greet patients, and respond to routine requests for information.
• Oversee the waiting area, coordinate patient movement, and report problems or irregularities.
• Organize and file progress notes, testing reports, and other chart-completion forms; assist with patient-chart filing.
• Open and distribute daily mail as needed.
• Review information to determine an appropriate course of action for patients and make referrals 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
• Career Level: Entry Level
• Education Level: High school or GED