About this role
QUALIFICATIONS
- Required: Work requires administrative skills and technical training as acquired in two years of college or equivalent work experience in a medical office.
- Medical terminology is required, as is proficiency with Microsoft Outlook and Excel.
- Work requires a comprehensive knowledge of hospital and physician referral protocol, as well as hospital policies and procedures normall acquired during two to three years of related experience.
- Must possess an ability to maintain excellent relationships with internal and external customers.
- Excellent verbal and written communication skills, including correct grammar usage, is required.
- Must participate and promote teamwork.
- Preferred: Experience processing patient referrals and obtaining insurance authorizations, including knowledge of ICD-10, CPT codes.
- Experience using electronic medical record system (Epic Information Systems Cadence/Referrals).
TYPICAL PHYSICAL/MENTAL DEMANDS
- Medium physical/mental capabilities required: Must be able to work independently and be self-starting as well as work with physicians, patients/family members and other co-workers courteously.
- Must be clear thinking and able to maintain a professional attitude and appearance.
- Able to work with time constraints, high stress situations, and multiple tasks.
- Must be able to walk/maneuver frequently in and around clinic building.
- Excellent problem solving skills required.
- Must have high degree of accuracy, attention to detail, and an ability to prioritize and organize work demands efficiently.
- Must be able to follow written and verbal instructions with accuracy.
ESSENTIAL JOB FUNCTIONS
- Demonstrate competence in relation to the defined mission, vision, values, and strategic plan of the organization. Apparent by ongoing completion of any or all of the following: demonstration of proficiencies, practice of Employee Standards of Excellence, Service Excellence initiatives, and timely completion of SWANK modules.
- Provide a high standard of customer service for clinic staff, physicians, and patients.
- Demonstrate professional and courteous communication skills. Supports a collaborative and cooperative environment in order to facilitate mutual respect and effective interpersonal relations.
- Demonstrate good problem solving and critical thinking skills.
- Review, research and process incoming referral requests received via fax, medical information exchange applications, and Epic.
- Verify insurance eligibility and benefits for referral purposes.
- Gather clinical data and payor criteria as needed to submit authorization requests via various electronic mediums.
- Maintain ongoing tracking and thorough documentation on referrals to promote team awareness and ensure patient safety.
- Track the status of all outgoing referrals to ensure appropriate appointment information and progress notes are received and the referral communication loop is closed.
- Maintain excellent communication with patients' care team members to keep them apprised of missed appointments and gaps in referred patient care.
- Other duties as assigned.
MARGINAL JOB FUNCTIONS
- Performs other duties as assigned.