Referral Specialist Connection Center

CommonSpirit Health•Prescott, AZ

2d•Onsite

About The Position

The Referral and Authorization Specialist II is responsible for ensuring patients have been authorized for specialty services and office visits; obtaining and issuing referrals for ancillary or consult visits; obtaining approval for all services needed. Acts as a liaison between the patient, provider/ referring provider, primary care provider, and other parties involved in the plan of care. Schedules and coordinates diagnostic testing and understands and communicates required preparation for diagnostic tests/ procedures. May act as escalation point for authorization denials. May additionally coordinate operating/procedure rooms, equipment, anesthesia, pre-op and imaging, authorizations and physician schedules for surgery. Resolves, pre-certification, registration and case-related concerns prior to a patients appointment. This includes interacting with patients, insurance carriers and various internal departments Completes the referral process for a patient's specialty referral needs. The process includes checking insurance coverage, sending approval and receiving confirmation, scheduling appointments and notifying patients of progress Completes full registration in Cerner Revenue Cycle when registering new patients. Ensure all patient information is updated/ current when following up/ interacting with patients. Verify insurance eligibility and benefits as appropriate for proposed services and procedures. Use Cerner EMR systems according to policy & procedures, including patient registration, scheduling appointments, template oversight (as applicable), printing forms and schedules, and posting payments and charge reconciliation. Reports any systems issues timely, while effectively utilizing downtime procedures as needed. Ensures co-pays are collected via cash, check, or credit card transactions. Deposits/batches are prepared according to DHMG YRMG policies. Assist with connection center phone lines on an as needed basis, displaying courtesy & professionalism at all times. All phone calls are to be answered and appropriate greeting is given including greeting, department name, your name and offer to assist.

Requirements

High School Graduate or GED
Minimum of two (2) years experience in a medical office or other healthcare environment
Basic Computer skills, Excel, Outlook, windows based programs
Basic Computer Hardware skills, setting up minimal workstations

Nice To Haves

Experience with Cerner Powerchart and Revenue Cycle EMR Applications
Previous experience with referral processing and authorizations
Certified Medical Assistant AAMA
Certified Clinical Medical Assistant
Bi-lingual

Responsibilities

Ensuring patients have been authorized for specialty services and office visits
Obtaining and issuing referrals for ancillary or consult visits
Obtaining approval for all services needed
Acting as a liaison between the patient, provider/ referring provider, primary care provider, and other parties involved in the plan of care
Scheduling and coordinating diagnostic testing
Understanding and communicating required preparation for diagnostic tests/ procedures
Acting as escalation point for authorization denials
Coordinating operating/procedure rooms, equipment, anesthesia, pre-op and imaging, authorizations and physician schedules for surgery
Resolving pre-certification, registration and case-related concerns prior to a patient's appointment
Completing the referral process for a patient's specialty referral needs
Checking insurance coverage, sending approval and receiving confirmation, scheduling appointments and notifying patients of progress
Completing full registration in Cerner Revenue Cycle when registering new patients
Ensuring all patient information is updated/current when following up/interacting with patients
Verifying insurance eligibility and benefits as appropriate for proposed services and procedures
Using Cerner EMR systems according to policy & procedures
Reporting any systems issues timely, while effectively utilizing downtime procedures as needed
Ensuring co-pays are collected via cash, check, or credit card transactions
Preparing deposits/batches according to DHMG YRMG policies
Assisting with connection center phone lines on an as needed basis, displaying courtesy & professionalism at all times