Overview : JOB DUTIES :
JOB DUTIES :
This position is responsible for processing referral requests for all providers practicing within the clinic module and ensuring that when needed, referral / authorization numbers are obtained for these services.
Essential Functions :
Attends Referral training class and various referral system training classes within 1st month of employment. Attends and actively listens and participates in the regularly scheduled Referral Coordinator meeting.
Remains current on referral policies and procedures, payer requirements and Managed Care Matrix utilizing the various on-line resources.
- Processes referrals for services requested by Providers within established guidelines.
- Obtains authorizations for referrals and schedules appointments as appropriate and within required timeframes. Coordinates appointment date, time and location with patients.
- Processes requests for additional referrals / authorizations when requested by providers.
- Assures referrals are maintained within appropriate network or payer requirement.
- Communicates with all stakeholders, staff, providers, payers and patients as appropriate and per procedure.
- Documents required information into the appropriate systems.
- Provides a standard of excellence as it relates to customer service for patients, staff members, and other customers.
- All other duties as assigned
Temperament :
Adhere to company policies and procedures, demonstrate the core values and Hospitality behaviors, resolve conflict through open, honest, professional communication, demonstrate positive and enthusiastic attitude, keep supervisor and leadership apprised of issues, and seek opportunities to recognize others.
Qualifications :
SKILLS, QUALIFICATIONS, AND REQUIRED EXPERIENCE :
Skills, Knowledge, Abilities :
Insurance
Knowledge of insurance plans and guidelines.
Insurance
Ability to obtain authorizations and pre-certifications from insurance plans.
Customer Service
Ability to provide dynamic customer service using various techniques including positive language, calming presence, attentiveness, clear communication, and patience.
Organization / Prioritization
Ability to manage multiple priorities and meet deadlines.
Communication
Ability to communicate effectively and courteously, both orally and in writing.
Organization / Prioritization
Ability to organize and prioritize assignments to work independently as well as a collaborative team member
Experience Requirements :
2 years Computer experience preferred
Diagnosis and Procedural coding preferred preferred
2 years Experience in the field or in a related area required
2 years Customer service required
2 years Third party payers (insurance carriers) using commonly used concepts, practices and procedures in the field required.
Education Requirements :
High School Diploma or GED equivalent required
Medical Terminology preferred
UFJPI is An Equal Opportunity Employer and Drugfree Workplace