Northern Light A.R. Gould Department: Physician Practice Central OpsPosition is located:Northern Light Health Center Fort FairfieldWork Type: Full TimeHours Per Week: 40.00Work Schedule: 8:00 AM to 4:30 PMSummary:Referral specialists are responsible for assuring that patients needing diagnostic tests and specialty services are referred to the appropriate department/office efficiently to assure services needed are received timely. They assist with insurance prior authorizations. The role of the referral specialist is critical to assure that every patient receives the definitive care that they need. A major role of the Referral Specialist is to communicate progress of referrals to patients, families, and referring providers. Key characteristics to be successful include expert communication, knowledge of insurances and health systems, teamwork, collaboration, organizational skills, and detail orientation. Multitasking ability is essential as Referral Specialists often are working on multiple cases at a time. Fast paced setting requires independent thinking, ability and willingness to be flexible and adaptable to changes. Re-prioritization of tasks occurs frequently.Responsibilities:
Manages outgoing referrals and incoming referrals as assigned.
Obtains authorizations for procedures and diagnostics as assigned.
Communicates with patients, providers, office staff, insurers and referrers. Works collaboratively with clinical staff, providers, surgical schedulers, ancillary departments, and insurance carriers to complete work.
Adds new patients to EMR when needed, including assisting with scheduling as assigned.
Manages and monitors prior authorizations/out-going referrals for the assigned departments(s) following Policy and Procedures.
Maintains working knowledge of inpatient vs. outpatient procedures and CPT codes.
Maintains referral tracking documentation to determine that referral is complete.
Maintains current knowledge of various insurance processes necessary to obtain prior authorization; follows Prior Authorization Policy.
Assists with claim denials/research as assigned.
Assists with coding to assure appropriate authorization of procedures.
Makes recommendations for change to improve processes in accordance with mission statement and established goals.
Ensures compliance with Medicare and third-party payers procedures.
Maintain safety standards at all times and report safety issues immediately.
Maintains mandatory education compliance.
Other Information:
Competencies and Skills
Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
No previous experience required.
Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
Education
Required Associate's DegreeAssociate degree in business management, healthcare, administration, medical coding, or related field or 2 years’ experience in a medical office or related setting is required.
Working Conditions
Prolonged periods of sitting.
Lifting, moving and loading less than 20 pounds.
Position Referral SpecialistLocation Req ID null