General Summary of Position
Responsible for making sure all referrals are complete, accurate and processed in a timely manner includes scheduling appointments and verifying that the patient has received the care PCP had requested.
Notifying PCP if patient did not follow through with referral. Educate patients regarding the health care plan they have chosen.
Act as a liaison between the primary care provider, patients, specialists, and health plans.
Primary Duties and Responsibilities
Completes referrals and / or pre-authorizations for diagnostic testing, therapy, surgical, durable medical equipment (DME), medications, and specialty care according to requirements.
Notifies physician(s) and patient when referral is approved, denied or if a second opinion or additional information is required.
Maintains up-to-date knowledge of all health care plans; educating patients regarding the health care plan they have chosen.
Interprets and communicates plan policies and procedures to associates, physicians and members (patients).
- Maintains referral record in electronic medical record.
- Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
- Identifies and resolves customer service issues. Monitors customer service trends and report to management as necessary.
- Answers patient, specialists, PCP's and testing facility questions and inquiries regarding their referrals.
- Maintains health care plan information and correspondence. Communicates with physicians and staff, as necessary with updates and / or changes.
- Maintains confidentiality and protects sensitive data at all times.
- Collects and presents data regarding health care utilization, referral patterns and preauthorization compliance on a regular basis (according to clinic operational policy).
Identifies specialists office needs to ensure successful patient care and experience.
Facilitate patient care process through to completion, scheduling of appointments, arranging interpreters and transportation if necessary.
Provide PHI to specialist to include follow up. Verifies that the patient has followed through with the referral.
Performs related duties as required.
Minimum Qualifications
Education
- High School Diploma or GED required
- Up to 1 year of formal job-related coursework required
- Completion of an accredited medical assistant or practical nurse program preferred
Experience
1-2 years in a primary health care or medical office including medical terminology and procedures required
Knowledge, Skills, and Abilities
- Knowledge of third-party payers and pre-authorization requirements
- Strong Microsoft office experience including excel and word
This position has a hiring range of $18.33 - $29.96
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