REFERRAL SPECIALIST

UHS•Denison, TX

About The Position

The Referral Specialist is responsible for scheduling referrals for patients, providers, pre-authorizing & pre-certing tests/procedures. Scheduling of other tests with facilities at the request of providers and/or staff. Directly communicates with the clinics, referred to clinics, and patients. Reviews clinical data to report medical necessity to insurance companies. Performs all work in accordance with the mission, vision, and values of the practice. Independence Physician Management (IPM), a subsidiary of UHS, was formed in 2012 as the physician services unit of UHS. IPM develops and manages multi-specialty physician networks and urgent care clinics that align with UHS acute care facilities. It also provides select services for the Behavioral Health division of UHS. Through continuing growth, IPM operates in 12 markets across six states and the District of Columbia. Our leadership team, practitioners, and teams of healthcare professionals are collectively dedicated to improving the health and wellness of people in the communities we serve. As a TexomaCare employee, you will be part of a first-class organization offering: Challenging and rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision, and Prescription Drug Plans 401(K) with company match and discounted stock plan Career development opportunities within UHS and its 300+ Subsidiaries! About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees. Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Requirements

High school graduate or GED required.
Minimum of two years’ experience in a healthcare or clinical setting.
Knowledge of clinical terminology, insurance billing, procedural and diagnosis coding, and federal and state insurance Regulations and HIPAA privacy standards is strongly preferred.
Typing, 10-key, and computer skills required.
Proficiency in Microsoft Office applications required.
Required effective interpersonal skills and excellent written, oral communication skills.
Acute healthcare knowledge and ability to evaluate clinical data to acquire pre-authorizations and referrals are 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.
Excellent planning and organizational skills.
Demonstration of strong analytical skills and problem-solving abilities.
Strong teamwork skills and the ability to effectively communicate with all management levels.
Results-oriented, independently goal-directed, able to multitask and meet established time frames.
Excellent customer service skills and must be able to work independently

Nice To Haves

Knowledge of clinical terminology, insurance billing, procedural and diagnosis coding, and federal and state insurance Regulations and HIPAA privacy standards is strongly preferred.
Acute healthcare knowledge and ability to evaluate clinical data to acquire pre-authorizations and referrals are preferred.
Knowledge of third-party reimbursement regulations is preferred.

Responsibilities

Scheduling referrals for patients, providers, pre-authorizing & pre-certing tests/procedures.
Scheduling of other tests with facilities at the request of providers and/or staff.
Directly communicates with the clinics, referred to clinics, and patients.
Reviews clinical data to report medical necessity to insurance companies.
Performs all work in accordance with the mission, vision, and values of the practice.