REFERRAL SPECIALIST- FAMILY MEDICINE

Johnson Memorial Hospital•Greenwood, IN

2d•Onsite

About The Position

The Referral Specialist- Family Medicine is responsible for verifying insurance coverage to initiate and/or perform the referral process. This role completes prior authorization processes and functions as a liaison between hospitals, physicians, patients, and health plans. The specialist will authorize insurance information and verify patient eligibility to prevent scheduling services with non-approved clinical specialists. They will act as a resource for patients, physicians, and nursing staff regarding questions and prior authorizations, and educate physicians and staff on insurance changes related to referrals and authorizations. The role requires staying up-to-date on contractual obligations with insurance companies, communicating effectively with patients about authorization approvals and denials, and maintaining positive communication with physicians and the organization. A knowledge base of medical terminology, ICD-10 codes, and primary diagnoses is essential. The specialist will support the Mission and Values of JMH, foster positive working relationships, and display leadership skills. Responsibilities include scanning documents into the JMH electronic medical record system, performing PSR duties when covering the check-in/out desk (greeting patients, verifying demographics and insurance, completing registration, preparing charts), answering multi-line phone calls, directing calls, and scheduling appointments. Additional duties may be assigned by the Senior Practice Manager and/or the JMH Vice President of Physician Practices. All activities must comply with applicable laws, regulations, standards, and JMH policies, including Blood and Body Substance Precautions.

Requirements

High School Diploma or equivalent required.
Knowledge base and continual understanding of medical terminology, ICD 10 codes, and primary diagnosis.

Nice To Haves

1-2 years of work experience in a medical or physician office setting.
General knowledge of information systems.
EMR technology experience preferred.

Responsibilities

Verifies insurance coverage to initiate and/or perform the referral process.
Completes prior authorization processes and functions as a liaison between hospitals, physicians, patients, and health plans.
Authorizes insurance information and verifies patient eligibility.
Acts as a resource to patients, physicians, and nursing staff for questions and prior authorizations.
Educates physicians and staff members regarding various insurance changes pertaining to referrals and authorizations.
Stays up to date regarding contractual obligations to specific insurance companies.
Communicates effectively with patients regarding approval and denials regarding authorizations.
Maintains effective and positive communication with physicians, members of the department and organization.
Scans documents into JMH electronic medical record system ensuring patient information and authorization(s) for service(s) are completed and accurate.
Performs PSR duties and responsibilities when covering PSR position at the check-in/out desk, which may include greeting patients, verifying and inputting accurate patient demographic and insurance information, completing the registration process, and preparing charts for appointments.
Answers multi-line phone calls, directs calls appropriately, and schedules appointments when needed.
Performs additional duties as assigned by the Senior Practice Manager and/or the JMH Vice President of Physician Practices.
Conducts all activities in compliance with applicable laws, regulations, standards, and JMH policies and procedures including Blood and Body Substance Precautions.