Referral Specialist, FT, Days

Prisma Health•Greenville, SC

22h•Onsite

About The Position

The Referral Specialist provides patients a seamless entry into the Prisma Health experience by interfacing with patients and physician office team members to accurately authorize various consultations, procedures, and tests. This role utilizes each patient's preferred method of contact and various electronic medical records to transmit required clinical documentation to third-party payors and Specialist Physicians. Key responsibilities include documenting all actions and encounters regarding the referral, ensuring timely follow-up with the patient, referring and referral physician practices, and third-party payors, covering aspects like pre-certification, cancelled and rescheduled appointments, and other events that might prevent the closure of the referral experience.

Requirements

High School diploma or equivalent
Two (2) years of related work experience.
Customer service skills
Communication skills
Interpersonal skills
Knowledge of various health insurance companies.
Knowledge of medical terminology, CPT and Diagnosis Coding, insurance verification and updates, and the authorization/precertification process.
Knowledge of Microsoft office products.

Nice To Haves

Experience in a physician front office to include patient registration and/or electronic scheduling and the authorization/precertification process

Responsibilities

Responsible for the authorization/precertification process to include coordinating with outside and internal organizations along with insurance companies to ensure prior approval requirements are met.
Presents necessary medical information such as history, diagnosis and prognosis.
Provides specific medical information to financial services to maximize reimbursement to the hospital and physicians.
Records demographic, coverage, and scheduling information in various systems.
Reminds patients of scheduled appointments via mail, internet, or telephone.
Ensures that patient’s primary care chart is up to date with scheduling information about specialist consults, tests, and procedures managed.
Alerts management to trends in appointment availability and appointment date timeliness.
Promotes hospital goals towards meaningful use in the electronic medical record on behalf of the referring physician.
Documents referral status and all scheduled appointments in appropriate system (electronic medical record) for referral tracking data.
Responsible for following up after patient’s consultation, procedure, and/or test to determine if physician has received report; continues to check on status until complete.
Serves as liaison between the provider, practice, patient and specialist providing the service.
Provides appropriate patient clinical information and referral needs to specialist office.
Verifies physician’s orders to ensure the accuracy of results and communicates with the patient the guidelines, protocols and location.
Assists patients in problem solving potential issues related to navigating the health care system, financial obligations or social barriers (e.g., request interpreters if appropriate, transportation services or prescription assistance).
May assume advocate role on the patient’s behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
Responds to patient’s scheduling requirements (date and time), questions and concerns to ensure patient experience expectations are met or exceeded.
Ensures timely appointments are booked, reviews details and expectations about the referral process with patients.
Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by Prisma Health.
Ensures the effective and efficient operation of the facility and to create an extraordinary patient, physician and team member experience.
Performs other duties as assigned.