REFERRAL SPECIALIST-Women's Health

Johnson Memorial Hospital•Franklin, IN

4h•Onsite

About The Position

The Referral Specialist is responsible for verifying insurance coverage, initiating and performing the referral process, and completing prior authorizations. This role functions as a liaison between hospitals, physicians, patients, and health plans, ensuring patient eligibility and preventing unapproved services. The specialist acts as a resource for questions and prior authorizations, educates staff on insurance changes, and stays updated on contractual obligations. Key responsibilities include effective communication with patients, physicians, and staff, maintaining knowledge of medical terminology and coding, and supporting the mission and values of Johnson Memorial Health (JMH). The position also involves scanning documents into the JMH electronic medical record system and performing Patient Service Representative (PSR) duties, such as greeting patients, verifying demographics and insurance, completing registration, preparing charts, and handling multi-line phone calls and scheduling appointments. Johnson Memorial Health is a nationally-recognized network of physicians, services, and healthcare resources based in Johnson County, Indiana, with Johnson Memorial Hospital as its centerpiece.

Requirements

High School Diploma or equivalent required.

Nice To Haves

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

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.
Authorize insurance information and verify patient eligibility to prevent accidentally scheduling services for treatment with clinical specialist who are not approved by their insurance provider.
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.
Knowledge base and continual understanding of medical terminology, ICD 10 codes, and primary diagnosis.
Clearly communicates and continuously supports the Mission and Values of 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.
Greet patients and all visitors (when covering PSR position).
Verify and input accurate patient demographic and insurance information (when covering PSR position).
Completes the registration process, which includes obtaining photo ID and signature(s) on patient intake forms (when covering PSR position).
Prepares charts for appointments, assuring that pertinent medical information and updated demographics/insurance information is placed in the patient’s chart (when covering PSR position).
Answers multi-line phone calls, directs calls appropriately, and schedules appointments when needed.
Performs additional duties not addressed here 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.