REFERRALS AND ELIGIBILITY SPECIALIST

Position Title : Referrals and Eligibility Specialist

Supervisor : Patient Access Manager

FLSA Status : Non-Exempt

Mission :

To provide our patients and community the most innovative and breakthrough treatment options to improve overall health and wellness.

Values : Patient Experience

Patient Experience

Innovation

Integrity

Teamwork

Job Summary :

The Referrals and Eligibility Specialist coordinates, oversees, and / or performs a wide variety of clinical and program support activities including scheduling, accounts receivable, accounts payable, and general maintenance of the clinic and practice management.

The Referrals and Eligibility Specialist task list includes, but is not limited to :

• Schedules all new patient appointments and enters information into a computerized schedule.
• Verifies insurance eligibility and benefits for clinic and surgery centers to ensure that it is active and billable.
• Assists with patient insurance correspondence.
• Obtains and verifies insurance referrals and authorizations as appropriate.
• Investigates and coordinates benefit and insurance errors.
• Communicates with referring clinics and providers.
• Coordinates obtaining medical records prior to new patient consultations.
• Collaborates with workers compensation and auto insurance adjustors to obtain necessary authorizations.
• Manages time appropriately between receipt of referral and initial consultation.
• Complies with organizational and HIPAA policies and regulations to ensure patient care is kept confidential.
• Performs miscellaneous job-related duties and tasks as assigned.

Supervisory Responsibility :

This position has no supervisory responsibilities.

Qualifications :

• High School Diploma or GED required. Bachelors Degree preferred.
• Minimum of one year of proven strong customer service, scheduling, and phone skills required.
• Minimum of one year of healthcare office experience with insurance eligibility required.

Skills & Abilities :

• Exceptional ability to listen and communicate to others.
• Good writing, analytical, and problem-solving skills.
• Ability to prioritize duties.
• Ability to follow oral and written instructions.
• Ability to operate standard office equipment.
• Strong computer skills.
• Ability to work well whether independently or as part of a team.
• Knowledge of principles and practices of basic office management and organization.

Work Environment :

While performing the duties of this job, the employee regularly works in an office setting.

Physical Demands :

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job :

While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to grasp or handle objects, tools, or controls;

reach with hands and arms; stoop, kneel, or crouch; talk or hear. The employee must occasionally lift or move up to 20 pounds.

Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Compensation & Work Schedule :

• Full-time : 40 hours / week
• Non-Exempt
• Day Shift Monday Friday; no evenings or weekends
• A competitive benefits package including medical, dental, vision, disability, and life insurance, 401(k) plan, PTO time, paid holidays, and HSA plan is offered.
5 days ago