Referral & Insurance Specialist - Piedmont Orthopaedic

Bon Secours Mercy Health•Greenville, SC

About The Position

The Referral and Insurance Specialist obtains insurance authorizations for referrals to physicians, medical facilities, procedures, testing, and medications. The role verifies eligibility and coverage, schedules appointments, communicates referral outcomes and instructions to patients, and supports billing and account resolution. It also involves gathering and entering patient, insurance, and charge information; posting payments; balancing daily collections; and maintaining patient records. The specialist helps maintain a positive, helpful environment and supports patient flow and routine office operations.

Requirements

High school diploma or GED.
Two to three years of experience in a related medical field with referral-processing experience is preferred.

Nice To Haves

Two to three years of experience in a related medical field with experience processing referrals.

Responsibilities

Obtain authorizations from insurers or pharmacy benefit managers for referrals, procedures, testing, and medications.
Verify patient eligibility and coverage by phone, fax, or Internet.
Schedule appointments with physicians and medical facilities for testing or care.
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 update patient, insurance, demographic, and charge information in billing systems.
Prepare daily patient charge encounter forms and update patient charts as needed.
Collect patient balances and copayments, balance money collected daily, and post payments to the appropriate patient accounts.
Collect and reconcile daily physician charge slips and enter charge information into the online billing system.
Assist patients with billing questions and account resolution; review information for appropriate action and refer patients to local DSS offices as appropriate.
Answer telephone calls, take messages, schedule appointments, greet patients, 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 chart documents; assist with patient chart filing.
Open and distribute daily mail as needed.
Promote positive interpersonal and interdepartmental relationships.