Referral Representative

Family HealthCare Network•Fresno, CA

10d•$25 - $30•Onsite

About The Position

The Referral Representative is responsible for assisting with patient referrals. This role involves coordinating and communicating with insurance carriers to obtain pre-authorizations, verifying patient eligibility, and scheduling appointments with external and internal specialists. The representative will also prepare comprehensive referral packets, submit documentation, and manage the processing of open referrals. Additionally, the role requires utilizing the electronic health record system, monitoring worklists, documenting all activities, and using third-party payer portals. The position also involves providing orientation to new providers, assisting with process analysis, and meeting specific referral productivity metrics. Adherence to the Attendance and Absenteeism Policy is crucial, as is the ability to work at any FHCN location. Performs other duties as assigned.

Requirements

Possesses work-related skills at a higher level than completion of high school, including formal written and verbal communications skills, computational and computer skills, mathematical, and technical skills.
Proof of completion of high school with a minimum overall GPA of 2.5 or completion of General Educational Development (GED) with a minimum overall score of 162.5, and health care-related knowledge frequently acquired through completion of a trade school, para-professional, or certificate-type program.
If an individual has completed a degree at a higher level than required by the role and had a stronger GPA in that program, they may provide proof of GPA from that degree in lieu of the high school diploma.
A minimum of two years of employment experience in a health care setting.
Ability to prepare more complex documents in Microsoft Word, including creating tables, charts, graphs and other elements.
Ability to use Microsoft Excel to review and compile data, including the use of formulas, functions, lookup tables and other standard spreadsheet elements.
Ability to create basic presentations in Microsoft PowerPoint.
Job duties require the compilation of information prepared in effective written form, including correspondence, reports, articles or other documentation.
Effectively conveys technical information to non-technical audiences.

Nice To Haves

Medical Assistant certification preferred.

Responsibilities

Assisting patients with the completion of referrals including multiple service lines.
Coordinating and communicating with various insurance carriers to obtain necessary pre-authorizations for patients to receive needed specialty services.
Appropriately verifying patient eligibility to determine the best options for specialty access.
Coordinating, communicating and scheduling patient appointments with external and internal specialists and provides communication to the patients regarding the process and referral status.
Ensuring proper use of CPT and current ICD-10 codes to meet the requirements of third-party payers and specialty offices to ensure minimal delay in securing referral appointments or pre-authorizations.
Preparing comprehensive referral packet, including referral order, pre-authorization paperwork, patient demographics, eligibility verification, primary care provider notes, diagnostics and/or lab work pertinent to the specialty referral.
Submitting required referral packet and documentation to the specialist to ensure timely processing of the referral.
Ensuring the efficient and timely processing of open referrals, including facilitating missing information, and that all referrals are appropriately closed and communicated to provider team.
Addressing incoming calls and questions from patients and specialists regarding referral orders, care coordination and ensure the appropriate follow-up is completed.
Coordinating surgeries with designated hospitals, specialists and patients. Obtains hospital pre-admission from the various health insurances and health plans.
Submitting referral activity reports to supervisor.
Utilizing the electronic health record system to obtain and document necessary information.
Monitoring assigned worklist throughout the day to capture referral requests in real time and organize workload based on acuity.
Documenting all referral processing activity, including interactions with patients, providers and specialists.
Utilizing third party payer/insurance portals appropriately to ensure adequate processing of referral orders.
Following-up on completion of the entire referral process, including closing referrals.
Providing orientation on the referral process to new providers and periodic in-services to existing providers and staff regarding referral process.
Assisting with process analysis feedback to streamline internal referral processes.
Achieving specific referral productivity metrics.
Adhering to the Attendance and Absenteeism Policy, recognizing that regular attendance is considered an essential function of all FHCN positions.
Ability to present to and work at any FHCN location, both at the beginning of a shift or during a shift, based on business need.
Performing other duties as assigned.