Referrals Representative

ADELANTE HEALTHCARE INC•Phoenix, AZ

6d•Onsite

About The Position

The Referral Representative processes patient referrals and educates patients about procedures and benefits related to referral needs. The role coordinates referrals with patients and specialist offices, processes insurance referrals, and serves as a liaison among patients, physicians, and insurance companies. The representative assists patients by phone according to call center standards and performs work in a friendly, courteous, and professional manner. Employees are expected to contribute to Adelante Healthcare and the community it serves while demonstrating commitment to quality, patient safety, employee engagement, innovation, integrity, professionalism, and competence. The position also supports interdisciplinary communication and collaboration in a patient-centered, team-based care model, and requires compliance with the organization’s policies, procedures, Compliance Program, and Standards of Conduct.

Requirements

One to two years of medical referral experience.
One to two years of customer service experience.
Basic knowledge of medical terminology.
Excellent verbal and written communication skills and a professional presence.
Ability to communicate effectively with patients, coworkers, and the public, in person and over the phone.
Accuracy and attention to detail.
Ability to prioritize and perform multiple tasks simultaneously.
Strong organizational skills.
Ability to work independently and as part of a team.
Microsoft Office skills, particularly Excel, Word, and Outlook.
Computerized database experience.
Office skills including typing, faxing, scanning, and telephone use.
High school diploma or GED from an accredited institution.
Commitment to Adelante Healthcare’s mission, vision, and values.
Willingness to be cross-trained and learn new skills and responsibilities.
Valid Level One Fingerprint Clearance Card issued by the Arizona Department of Public Safety for specialty behavioral health locations.

Nice To Haves

Experience in community health.

Responsibilities

Initiate and manage clinical referrals for pre-authorization.
Act as a liaison between health plans, physicians, patients, and other referral sources.
Review referrals for completeness and follow up for additional information when necessary.
Respond to inbound calls initiating exam requests, following established processes and meeting quality and production standards.
Contact physician offices to obtain demographic information or related data as needed.
Enter referrals, referral denials, insurance authorizations, communications, and actions into patient account histories.
Schedule initial and follow-up patient appointments, using provider time efficiently and supporting appropriate patient care.
Perform patient pre-registration, including accessing and updating patient information as indicated.
Follow established procedures for answering and screening appointment-related calls, scheduling interpreters, and directing calls to appropriate staff.
Attend staff meetings, in-service meetings, and other required meetings.
Maintain satisfactory attendance, be punctual, and work the full scheduled shift.
Meet minimum standards for metric expectations.
Promote and participate in interdisciplinary communication and collaboration to support quality care and patient wellness.
Comply with Adelante Healthcare’s written standards, including its Compliance Program, Standards of Conduct, policies, and procedures, and report potentially noncompliant conduct.
Perform other duties as requested or assigned.