Referral Representative

Intermountain Health • Grand Junction, CO

3d • Onsite

About The Position

The Referral Representative processes insurance pre-authorization for primary and specialty service office visits and testing. Receives and gathers pertinent information from patients, providers, insurance carriers, and other staff to confirm the patient’s financial obligations for services. Acts as liaison between clinical staff, health plans, providers and patients to obtain insurance authorizations acting as the patient advocate in this circumstance. Verifies insurance coverage and obtains required authorization when necessary. Documents referral information, communications, actions and other data in electronic medical information systems to communicate to other staff a patient’s authorization progress. Schedule - Monday - Thursday 8:30am - 5:00pm and Friday 7:30am - 4:00pm Essential Functions Administrative departmental support, including processing into and through electronic medical records internal, external, and outbound referrals while assembling, researching, and triaging information about patient demographics, insurance, and medical needs. Maintains ongoing tracking and appropriate detailed documentation of referrals to promote team awareness and ensure patient safety. Follows regulatory requirements as defined by provider or specialty department to route inbound referral appropriately. Including appropriate documentation, imaging, or any other requirements while maintaining Intermountain standards for adding and scanning required information into electronic medical records. Liaison between patient, clinic, and insurance carrier to set details related to upcoming visit with Intermountain providers or scheduled procedures prior authorization requirements. Coordinates provider peer to peer interactions as it pertains to obtaining insurance approvals. Generates cost estimates for services as it relates to office visits and in-office testing; directs patients to financial counseling resources when appropriate. Contacts insurance company representatives or their contracted review organizations to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis, and prognosis. Assumes the advocate role on the patient’s behalf with the insurance carrier to ensure approval of necessary services for the patient in a timely fashion. Multiple partnerships with Patient Service Representatives and Clinical Staff for effective pre-registration and pre-visit preparation as needed. Also collaborates with Payer Relations to provide the required documentation relating to any denial or appeal information needed. All other duties as needed Utilization of different insurance platforms and medical records systems according to department protocols to include accurate data entry and retrieval of information for reporting purposes. Meets performance standards, volume metrics while aligning with mission, vision, and values.

Requirements

• Have a level of computer literacy that ensures accuracy and timeliness.
• Demonstrated ability to work well with coworkers and patients.
• Ability to collaborate with multiple teams.
• Skill to write clearly and professionally.
• Be thorough, precise and detail oriented.
• Knowledgeable in navigating Microsoft systems (Word, Outlook, Excel, OneNote).

Nice To Haves

• Experience with electronic medical records (EPIC).
• CNA, MA, EMT or healthcare or health plan experience.
• Referral coordination experience.
• Medical terminology knowledge.

Responsibilities

• Processes insurance pre-authorization for primary and specialty service office visits and testing.
• Receives and gathers pertinent information from patients, providers, insurance carriers, and other staff to confirm the patient’s financial obligations for services.
• Acts as liaison between clinical staff, health plans, providers and patients to obtain insurance authorizations.
• Verifies insurance coverage and obtains required authorization when necessary.
• Documents referral information, communications, actions and other data in electronic medical information systems.
• Maintains ongoing tracking and appropriate detailed documentation of referrals.
• Follows regulatory requirements to route inbound referral appropriately.
• Coordinates provider peer to peer interactions as it pertains to obtaining insurance approvals.
• Generates cost estimates for services.
• Contacts insurance company representatives or their contracted review organizations to ensure prior approval requirements are met.
• Presents necessary medical information such as history, diagnosis, and prognosis.
• Assumes the advocate role on the patient’s behalf with the insurance carrier to ensure approval of necessary services.
• Partners with Patient Service Representatives and Clinical Staff for effective pre-registration and pre-visit preparation.
• Collaborates with Payer Relations to provide the required documentation relating to any denial or appeal information needed.
• Utilizes different insurance platforms and medical records systems according to department protocols.
• Meets performance standards and volume metrics.

Benefits

• Comprehensive benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed