Referral & Insurance Specialist - Pain Management

Mercy Health BSMH • Paducah, KY

7d

About The Position

The Referral and Insurance Specialist obtains insurance authorizations for physician referrals, procedures, testing, and medications; verifies eligibility and coverage; and schedules appointments with physicians and medical facilities. The role also handles billing and account support, including gathering and entering patient and charge information, posting payments, reconciling charge slips, investigating billing issues and denials, and helping patients resolve billing questions and account balances.

The specialist supports clinic operations by answering calls, scheduling appointments, greeting patients, preparing and maintaining charts, organizing records, coordinating patient movement, and assisting with routine office needs. The position promotes positive interpersonal and interdepartmental relationships and may review patient information to determine an appropriate course of action, including referrals to local DSS offices when appropriate.

Requirements

• High school diploma or GED.
• Licensure or certification is not required.

Nice To Haves

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

Responsibilities

• Obtain authorizations from insurance companies for referrals to physicians or medical facilities and for procedures, testing, and medications.
• Verify eligibility and coverage for referrals and testing by phone, fax, or Internet.
• Schedule 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 and corrections to maintain accurate billing-system information.
• Answer telephone calls, 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 records needed to complete charts; assist with filing patient charts.
• Collect patient responsibility balances and copayments as needed and balance collected money daily.
• Open and distribute daily mail as needed.
• Collect daily physician charge slips and reconcile the number of slips and their 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 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: Mid Level
• Education Level: High school or GED