Referral Specialist

*Job Description**Position Description: *Medical Referral Specialist *Purpose: *Assures that all referrals are managed effectively and efficiently for Metropolitan Community Health Services, Inc.
; providing high-level customer service to both referring physicians as well as referred patients.
Obtains pre-authorization for all medical insurances requiring authorization, performs additional administrative support functions as required.
This job requires the application and interpretation of policies and procedures, utilizing independent judgment in a medical setting.
The individual must possess the ability to maintain a working knowledge of carrier contracts/changes and departmental policies and procedures for internal referrals.
*Responsibilities:* * Assures all referrals are handled effectively and efficiently a.
Collaborates with referring physician offices to ensure referral forms are completed appropriately b.
Enters necessary information into applicable database c.
Retrieves medical records and critical information from referring provider(s) prior to patient office visits; ensures that all necessary laboratory, imaging test results, and medical records are obtained d.
Registers patients, collect insurance information and collaborates with business entities to ensure appropriate insurance information and prior authorizations are obtained e.
Follows up and documents on pending referrals f.
Informs patient of their referral responsibilities * Analyzes information required to complete pre-authorizations with insurance carrier and service area contacts a.
Accurate and pertinent clinical data and demographics is compiled and communicated to the patient’s insurance company in a timely and organized fashion b.
Basic knowledge of insurance criteria for Medicaid and Medicare * Demonstrates the skills of effective communication, decision-making and organization to ensure efficient job performance and job success a.
Daily work is accomplished with minimal direct supervision b.
Work priorities are set in order to accomplish task/goals c.
Confidential matters are handled appropriately d.
Familiarity with CPT codes/ ICD-9 e.
Sound judgment is consistently demonstrated as to when to involve physician or other health care professionals in the pre-authorization or denial process * Provides high-level customer service to both referring physicians as well as referred patients a.
Provides initial “meet and greet” services over the telephone to patients and physicians b.
Provides patent with an overview of the evaluation process.
Triages and manages more complex patient calls, using appropriate customer service skills c.
Establishes positive relationships with referring physician offices * Develops tools to assess patient referral processes with respect to efficiency and customer service.
a.
Performs all related task which would facilitate the flow of patients through the process, or which would enhance the quality of service to patients b.
Practice/procedure changes are implemented in a timely and correct manner * Provides service in a professional and courteous manner a.
Confidentiality of patient data is maintained at all times b.
Workspace is maintained in an organized and professional manner c.
Courteous and professional demeanor is demonstrated at all times d.
Information for patients and staff is delivered in a manner that is supportive, timely and understandable e.
Interpersonal conflicts are resolved using appropriate methods and organizational resources (supervisor, physician) f.
Privacy is maintained at all times for patient and employee information g.
Relationships with staff in other work areas are fostered to meet internal and external customer needs h.
Organizational mission and values of respect, integrity, stewardship and excellence are evident in behaviors * Participates in performance improvement activities a.
Participation in performance improvement activities and initiatives is on-going b.
Initiative is demonstrated to proactively diagnose and resolve problems c.
Change is met with positive, supportive behavior * Participates as a team member and is accountable for own work responsibilities a.
Time off scheduled to avoid disrupting workflow b.
Help is offered to others to solve problems and complete tasks to facilitate communication and positive team dynamics c.
Accountability for actions and decisions is demonstrated in daily work d.
Feedback is solicited and accepted in a positive manner e.
Constructive input is offered to support the work of the unit *Minimum Requirements:* High School Graduate or Equivalent.
Experience: 2 or more year experience required.
License/Certification: None required.
Job requires siting for prolonged periods, frequently bending/stooping, reaching (overhead, extensive, repetitive: repetitive motion: computer keyboard.
Proficient communicative, auditory and visual skills; Attention to detail and ability to write legibly; Ability to lift/push/pull 20-50lbs.
I have read this job description and it has been discussed with me by my supervisor.
THIS JOB DESCRIPTION DOES NOT CONSTITUTE A CONTRACT FOR EMPLOYMENT Job Type: Full-time Benefits: * 401(k) matching * Dental insurance * Health insurance * Life insurance * Paid time off Schedule: * 8 hour shift Education: * High school or equivalent (Preferred) Experience: * referral authorization: 1 year (Preferred) * Computer Skills: 1 year (Preferred) Ability to Relocate: * Washington, NC 27889: Relocate before starting work (Required) Work Location: In person