Referral Specialist - Orthopedics - FT

Prisma Health - Columbia, SC

Full-time

Columbia, SC

Hospitals

About the position

The Referral Specialist in Orthopedics at Prisma Health plays a crucial role in ensuring patients have a seamless entry into the healthcare system. This position involves interfacing with patients and physician office teams to authorize consultations, procedures, and tests, while also managing communication and documentation throughout the referral process. The specialist is responsible for coordinating with various stakeholders to ensure timely and accurate referrals, ultimately enhancing the patient experience.

Responsibilities

• Provide patients with a seamless entry into the Prisma Health experience.
• Interface with patients and physician office team members to authorize consultations, procedures, and tests.
• Utilize electronic medical records to transmit required clinical documentation to third-party payors and specialist physicians.
• Document all actions and encounters regarding referrals, including follow-ups with patients and physicians.
• Coordinate the authorization/precertification process with insurance companies and other organizations.
• Present necessary medical information to maximize reimbursement for the hospital and physicians.
• Accurately record demographic, coverage, and scheduling information in various systems.
• Remind patients of scheduled appointments via mail, internet, or telephone.
• Ensure primary care charts are updated with scheduling information about specialist consults, tests, and procedures.
• Alert management to trends in appointment availability and timeliness.
• Promote hospital goals towards meaningful use in electronic medical records.
• Document referral status and scheduled appointments for tracking purposes.
• Follow up after consultations, procedures, and tests to ensure reports are received by physicians.
• Serve as a liaison between providers, practices, patients, and specialists.
• Communicate appropriate patient clinical information and referral needs to specialist offices.
• Assist patients in navigating the healthcare system and addressing financial or social barriers.
• Respond promptly to patient scheduling requirements and concerns to meet expectations.
• Ensure timely appointments are booked and review referral process details with patients.
• Maintain patient confidentiality and comply with HIPAA guidelines.

Requirements

• High school diploma or GED.
• Two years of comparable experience, preferably in a physician front office setting.
• Excellent customer service skills.
• Strong oral and written communication skills.
• Knowledge of various health insurance companies.
• Familiarity with medical terminology, CPT and Diagnosis Coding, and the authorization/precertification process.
• Proficiency in Microsoft Office products.
• Ability to pass a data entry test with 90% accuracy.