Referral Representative - Pediatric Contact Center

Erlanger•Chattanooga, TN

8d•Onsite

About The Position

This position is responsible for obtaining referrals, pre-certifications, and prior-authorizations through various methods including internet, fax, and phone calls to insurance companies. The role involves scheduling all procedures, diagnostic tests, and necessary pre-certifications, as well as following up to confirm appointments and notify patients. Accurate documentation of all referrals, procedures, and tests in log books is required. The representative will also obtain prior authorizations for non-formulary medications, verify patient insurance 24 hours prior to appointments, and resolve any eligibility issues. This role acts as a backup for the PSR position and performs general office duties such as data entry and filing. Additional responsibilities may include Invision/Flowcast registration and other designated functions. The position operates within a team-based approach to care, with team members trained to meet high functional levels according to State of Tennessee/Georgia guidelines. This includes coordinating patient care, supporting patient self-management and behavior change, and managing the practice's patient population. Participation in quality improvement processes and performance evaluation is expected. The role requires interaction with third-party payers and other departments, and communication with a diverse socio-economic population. Strong organizational skills and a commitment to teamwork are essential. The work environment is clinical, involving stressful situations, requiring personal flexibility, moderate sitting, standing, stooping, bending, and work at portable computers. Close collaboration with other physician offices to stay updated on scheduling, registration, and referral changes is necessary.

Requirements

High school diploma and training for computer competency.
Proven excellent communication skills.
Ability to interface appropriately with others of multiple ethnic and educational backgrounds.
Highly organized, detail-oriented, self-starter with strong math skills.
Ability to function efficiently and professionally with all customers, both internal and external, in a demanding environment.
Clerical experience and/or hospital experience.
Poised, courteous, pleasing personality and great telephone etiquette.
Knowledge of general business principles in a related healthcare or business field, or equivalent combination of education and experience.
Previous experience with appointment scheduling, referrals, patient registration, and data entry.
Assist with other office functions such as chart preparation, as needed.
Strong organizational skills.
Commitment to teamwork.
Personal flexibility.
Moderate sitting, standing, stooping, bending required.
Moderate work at portable computers required.

Nice To Haves

Medical terminology course desired.
Prior Centricity/Flowcast/Invision/SMS experience desirable.

Responsibilities

Obtain referrals, pre-certifications, and prior-authorizations via internet, fax, and phone calls to insurance companies.
Schedule all procedures and necessary pre-certification.
Schedule all diagnostic tests and necessary pre-certification.
Follow up on all scheduled referral appointments, diagnostic testing, and procedures, confirming date/time and patient notification.
Document all referrals, procedures, and diagnostic tests in appropriate log books.
Obtain Prior Authorizations for medications not included on patient formularies.
Verify patient insurance 24 hours prior to scheduled appointment time.
Troubleshoot and eliminate any patient eligibility issues identified.
Act as back-up for the PSR position(s).
Perform general office duties such as data entry and filing.
May be responsible for Invision/Flowcast registration and other functions as designated.
Perform any other duties as directed.
Coordinate care for patients.
Support patients/families/caregivers in self-management, self-efficacy, and behavior change.
Manage the practice's patient population.
Participate in the practice's quality improvement process and performance evaluation.
Interact with third-party payers and other departments.
Communicate with people of a broad socio-economic mix.
Work closely with other physician offices to keep abreast of any new updates or changes with regards to scheduling, registration and referrals.