Referral Specialist Gastroenterology

Banner Health•Mesa, AZ

4d•Onsite

About The Position

This position is responsible for coordinating referral orders for a continuation of treatment, such as specialty services and diagnostic testing within a primary care practice. This position provides all pertinent clinical information needed for the payor authorization and the facility or specialist prior to the services being rendered. The position is responsible for tracking and managing all referrals with the intention and outcome to close any patient care gaps, along with providing documentation to promote team awareness. As a Referral Specialist you will verify and update patient registration information in the system/chart. Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all specialty consultations and follow ups, uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility; attaches referrals and authorizations to patients’ chart for billing purposes; will process roughly 50 referrals a day; and assist with phones as needed. We are an engaging team with a definite potential for growth. Bring your desire to learn and grow with us to our ever-growing GI clinic, where you’ll be working side by side with medical staff to create a great patient experience. Bring your dedication and determination to succeed. You will have a daily opportunity to learn new things and utilize your decision-making skills to make a difference in the lives in our patients.

Requirements

High school diploma/GED or equivalent working knowledge.
Possesses 1 year of direct patient interaction/experience in a medical, insurance, or healthcare related industry.
Knowledge of HIPAA regulations.
Strong customer service focus and willingness to problem solve.
Effective verbal and written communication skills and the ability to manage competing priorities.
Must be proficient with commonly used office software.

Nice To Haves

Previous knowledge of managed care concepts.
Working knowledge of medical terminology and ICD-9 and CPT codes.
Additional related education and/or experience preferred.

Responsibilities

Schedules appointments for specialty physician services and diagnostic testing per provider request and communicates with the patient on a timely basis for all scheduling requirements
Acts as a liaison between patients, providers and staff members for patients’ referral and follow up needs. Provides prompt and professional service for the patients by assisting in educating patient/family and assisting patients with external resources when needed.
Provides all pertinent clinical information needed for the payor authorization, the facility or specialist prior to the services being rendered by verifying coverage, obtaining authorization and communicating with receiving facilities
Tracks and manages all referrals by monitoring outstanding referrals at 30/60/90 day intervals and following up with patients if appointments are not kept
Applies knowledge of medical terminology and maintains up to date knowledge of insurance environment. Utilizes internal and external resources to seek knowledge about regulations regarding various payor sources
Collaborates with outside referral sources and other community resources. Maintains an updated list of community resources and networks with colleagues to develop additional referral sources
Verifies and updates patient registration information in the system/chart.
Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all specialty consultations and follow ups.
Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.
Attaches referrals and authorizations to patients’ chart for billing purposes.
Processes roughly 50 referrals a day.
Assists with phones as needed.