REFERRAL SPECIALIST- FAMILY MEDICINE

Johnson Memorial Hospital•Greenwood, IN

2d•Onsite

About The Position

The Referral Specialist will verify 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 accidentally scheduling services for treatment with clinical specialists who are not approved by their insurance provider. They will act as a resource to patients, physicians, and nursing staff for questions and prior authorizations. Additionally, the Referral Specialist will educate physicians and staff members regarding various insurance changes pertaining to referrals and authorizations, and stay up-to-date regarding contractual obligations to specific insurance companies. Effective communication with patients regarding authorization approvals and denials is crucial, as is maintaining positive communication with physicians, department members, and the organization. A knowledge base and continual understanding of medical terminology, ICD 10 codes, and primary diagnosis are required. The role involves clearly communicating and continuously supporting the Mission and Values of Johnson Memorial Health (JMH), fostering positive working relationships, and displaying leadership skills in working with physicians, staff, outside medical facilities, hospitals, and outpatient services. The specialist will scan documents into the JMH electronic medical record system, ensuring patient information and authorization(s) for service(s) are completed and accurate. The role may also perform PSR (patient service rep) duties when covering the PSR position at the check-in/out desk, which may include greeting patients and visitors, verifying and inputting accurate patient demographic and insurance information, completing the registration process, and preparing charts for appointments. Answering multi-line phone calls, directing calls appropriately, and scheduling appointments are also part of the duties. Additional duties may be assigned by the Senior Practice Manager and/or the JMH Vice President of Physician Practices. All activities must be conducted in compliance with applicable laws, regulations, standards, and JMH policies and procedures, including Blood and Body Substance Precautions.

Requirements

High School Diploma or equivalent required.
General knowledge of information systems.
EMR technology experience preferred.

Nice To Haves

1-2 years of work experience in a medical or physician office setting.

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.
Maintains knowledge base and continual understanding of medical terminology, ICD 10 codes, and primary diagnosis.
Clearly communicates and continuously supports the Mission and Values of Johnson Memorial Health (JMH).
Fosters positive working relationships and displays leadership skills in working with physicians, staff, outside medical facilities, hospitals, and outpatient services.
Scans documents into JMH electronic medical record system ensuring patient information and authorization(s) for service(s) are completed and accurate in the patient medical record.
Performs PSR (patient service rep) duties and responsibilities when covering PSR position at the check-in/out desk, which may include greeting patients and visitors, 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.