Referral Specialist- Family Medicine

Johnson Memorial Hospital•Greenwood, IN

2d•Onsite

About The Position

This role is responsible for verifying insurance coverage to initiate and/or perform the referral process. The Referral Specialist completes prior authorization processes and acts as a liaison between hospitals, physicians, patients, and health plans. They authorize insurance information and verify patient eligibility to prevent scheduling services with specialists not approved by the patient's insurance. This position serves as a resource for patients, physicians, and nursing staff regarding questions and prior authorizations. The Referral Specialist educates physicians and staff on insurance changes related to referrals and authorizations, stays updated on contractual obligations, and communicates effectively with patients about authorization approvals and denials. Maintaining positive communication with physicians, department members, and the organization is key. A strong knowledge base of medical terminology, ICD-10 codes, and primary diagnoses is required. The role involves supporting the Mission and Values of Johnson Memorial Health (JMH) while fostering positive working relationships and demonstrating leadership skills. Responsibilities also include scanning documents into the JMH electronic medical record system, ensuring accuracy of patient information and authorizations. Additionally, the Referral Specialist may perform Patient Service Representative (PSR) duties, including greeting patients, verifying demographics and insurance, completing registration, preparing charts, answering phones, 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 and procedures, including Blood and Body Substance Precautions.

Requirements

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

Nice To Haves

Prefer 1-2 years of work experience in a medical or physician office setting.
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 in the patient medical record.
Performs PSR 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, preparing charts for appointments, and answering multi-line phone calls, directing calls appropriately, and scheduling appointments when needed.
Conducts all activities in compliance with applicable laws, regulations, standards, and JMH policies and procedures including Blood and Body Substance Precautions.