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Referral Specialist (BOH)

Referral Specialist (BOH)

Beacon Health SystemSouth Bend, Indiana, United States, 46628
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Referral Specialist (BOH)

Reports to the Manager and works under the direction of the established policies and procedures. Responsibilities include scheduling specialty and / or diagnostic exams and procedures, answering and triaging incoming phone calls, and communicating with empathy and clarity.

MISSION, VALUES and SERVICE GOALS

  • MISSION : We deliver outstanding care, inspire health, and connect with heart.
  • VALUES : Trust. Respect. Integrity. Compassion.
  • SERVICE GOALS : Personally connect. Keep everyone informed. Be on their team.

Referral Specialist / Integrated Care duties in accordance with established policies and procedures by :

  • Coordinating care that is customer centric; timely, convenient and coordinated.
  • Using knowledge of CPT codes and ICD-10 to ensure exam meets medical necessity and procedural guidelines.
  • Ensuring referrals are scheduled using knowledge of insurance network guidelines, in accordance with the customer`s insurance rules and Regulations.
  • Communicating with the provider in a collaborative and confident manner.
  • Ensuring proper testing is done utilizing tools in accordance with the provider's desire and the testing criteria and guidelines including both insurance and modality ordering guidelines
  • Recognizing issues using critical thinking skills to prevent denials.
  • Coordinating care within the Beacon Health System by using identified best practice tools and resources to their highest potential.
  • Scheduling all testing (Outpatient Diagnostic and Specialty) appointments in a manner that is customer centric.
  • Interpreting physician's instructions and communicates instructions in a clear manner and can adjust communication style to meet the needs of the customer when necessary.
  • Assisting management team to identify referral patterns by inputting referral data into the referral database in a detailed, thorough manner.
  • Using critical thinking skills to identify problems, create solutions and helping to implement the change.
  • Prioritizing work in an effective manner.
  • Working at a fast pace and maintaining accuracy.
  • Maintaining up-to-date knowledge and stays abreast of changes and updates as they occur. (Includes but not limited to, Insurance, Referral Database, Department and Processes changes.
  • Advocating for the customer by displaying the ability to recognize when to dispute a non-desirable outcome regarding PA approval (prior authorization).
  • Disputing and negotiating when necessary on behalf of BHS and the customer for a positive prior authorization outcome.
  • Understanding the flow and rhythm of each task and can connect each resulting convenient, connected and coordinated care.
  • Using numerous software platforms (multiple EMR's, insurance websites, referral database, scheduling software, etc.) to conduct tasks for patient care.

    • Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by :

  • Assisting others and / or accept additional duties.
  • Enhancing professional growth and development through in-service meetings and educational programs as approved.

    • ORGANIZATIONAL RESPONSIBILITIES

  • Associate complies with the following organizational requirements :
  • Attends and participates in department meetings and is accountable for all information shared.
  • Completes mandatory education, annual competencies and department specific education within established timeframes.
  • Completes annual employee health requirements within established timeframes.
  • Maintains license / certification, registration in good standing throughout fiscal year.
  • Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position / department.
  • Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
  • Adheres to regulatory agency requirements, survey process and compliance.
  • Complies with established organization and department policies.
  • Available to work overtime in addition to working additional or other shifts and schedules when required.

    • Commitment to Beacon's six-point Operating System, referred to as The Beacon Way :

  • Leverage innovation everywhere.
  • Cultivate human talent.
  • Embrace performance improvement.
  • Build greatness through accountability.
  • Use information to improve and advance.
  • Communicate clearly and continuously.

    • Education and Experience

  • The knowledge, skills and abilities as indicated are normally acquired through the successful completion of a high school diploma or equivalent; successful completion of an approved Medical Assistant Program with successful completion of the Certification Exam or equivalent medical office experience. Medical terminology, ICD-10, CPT, / prior authorizations, and specialty / diagnostic referral experience required.

    • Knowledge & Skills

  • Demonstrates well developed communication skills to communicate effectively and clearly to a variety of internal and external contacts.
  • Demonstrates analytical skills necessary to solve problems and interpret data.
  • Promotes collaboration and innovation in the clinical services to ensure an interdisciplinary approach to improving healthcare delivery and the quality of patient care.
  • Must be tactful in handling patient problems often of a highly personal and confidential nature.
  • Must be able to maintain professionalism during potential frustrating interpersonal situations.
  • Demonstrates a high knowledge level of procedures; including knowledge of CPT codes and ICD-10 Codes.
  • Demonstrates a working knowledge (referrals) high knowledge (prior authorization) of insurance network guidelines to ensure the referral is scheduled in accordance with customer's insurances rules and regulations

    • Working Conditions

  • Assigned hours within your shift, starting time, or days of work are subject to change based on departmental and / or organizational needed.
  • May need to travel to other Beacon locations.
  • Working space is frequently congested by other personnel.
  • Constantly exposed to noise and distraction.

    • Physical Demands

  • Requires the physical ability and stamina to perform the essential functions of the position.
  • Sitting for long periods of time in front of a computer monitor.

    • PI1261cd6d7d54-30511-38685787

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    Referral Specialist • South Bend, Indiana, United States, 46628

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