Referral Specialist

UHS•Edinburg, TX

About The Position

Join our South Texas Health System Clinics (formerly Valley Care Clinics) team! Providers with South Texas Health System (STHS) Clinics deliver high quality family medicine, health screenings and advanced specialized care to the people of the Rio Grande Valley. STHS Clinics is committed to delivering quality healthcare and service excellence. Our clinics are affiliated with South Texas Health Systems’ four acute care hospitals, behavioral health hospital, six freestanding emergency rooms and one joint venture hospital. Specially trained and highly experienced, our physician group treats a wide range of conditions using advanced technologies and minimally invasive techniques. Website: sthsclinics.com The Referral Specialist is responsible for scheduling referrals for patients and providers, as well as pre-authorizing and pre-certifying tests/procedures Scheduling of other tests with facilities at the request of providers and/or staff. Communicates effectively with patients, clinics, and hospitals. Reviews clinical data to report medical necessity to insurance companies. Performs all work with accord to the mission, vision, and values of the practice.

Requirements

High school graduate or GED required
Minimum of 1-3 years of experience in a healthcare or clinical setting.
Knowledge of clinical terminology, insurance billing, procedural and diagnosis coding, federal and state insurance.
Knowledge of regulations and HIPAA privacy standards is strongly preferred.
Typing, 10 key, and computer skills required.
Proficiency in Microsoft Office applications required.
Acute healthcare knowledge and ability to evaluate clinical data to acquire pre-authorizations and referrals is preferred. Knowledge of third-party reimbursement regulations is preferred.
Patient Management, Billing and Managed Care system processes competency.
Understanding of functions and workflow of Clinical/Hospital departments

Responsibilities

Schedules tests and referral appointments within 24 hours from receiving the physician order. Notifies patients within 24 hours of their appointment.
Pre-certify appropriate tests with insurance companies within 48 hours of physician order. Communicate pre-certification results to the patient and/or office in a timely matter.
Communicates effectively with patients, clinics, and hospital. Communicates information to appropriate areas, departments, and individuals. Addresses patients in a polite, prompt, and helpful manner. Answers the phone within four (4) rings in a courteous manner identifying self and department
Demonstrates knowledge and skills to operate EMR software efficiently and effectively. Uses referral tool in EMR for all documentation. Demonstrates knowledge of computer downtime procedures.
Maintains a clean and orderly office and waiting area. Orders supplies for the office within budgetary guidelines. Returns all emails within 48 hours.
Other duties as assigned.