Primary City/State:
Mesa, Arizona
Department Name:
Internal Medicine-BDMC
Work Shift:
Day
Job Category:
Administrative Services
Great careers are built at Banner Health. We understand that talented health care professionals appreciate having options. We are proud to offer our team members many career and lifestyle choices throughout our network of facilities. Apply today, this could be the perfect opportunity for you.
As a Referral Specialist you will verify and update patient registration information in the system/chart. Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all specialty consultations and follow ups, uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility; attaches referrals and authorizations to patients' chart for billing purposes; will process roughly 50 referrals a day; and assist with phones as needed. We are an engaging team with a definite potential for growth. Bring your desire to learn and grow with us to our ever-growing Gastroenterology clinic, where you'll be working side by side with medical staff to create a great patient experience. A love for working with adult patients over the phone, is a definite plus. Bring your dedication and determination to succeed. You will have a daily opportunity to learn new things and utilize your decision-making skills to make a difference in the lives in our patients.
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Location: Banner Medical Group (1300 S Country Club Dr, Suite 3)
Schedule: 8:00am-5:00pm
POSITION SUMMARY
This position is responsible for coordinating referral orders for a continuation of treatment, such as specialty services and diagnostic testing within a primary care practice. This position provides all pertinent clinical information needed for the payor authorization and the facility or specialist prior to the services being rendered. The position is responsible for tracking and managing all referrals with the intention and outcome to close any patient care gaps, along with providing documentation to promote team awareness.
CORE FUNCTIONS
1. Schedules appointments for specialty physician services and diagnostic testing per provider request and communicates with the patient on a timely basis for all scheduling requirements
2. Acts as a liaison between patients, providers and staff members for patients' referral and follow up needs. Provides prompt and professional service for the patients by assisting in educating patient/family and assisting patients with external resources when needed.
3. Provides all pertinent clinical information needed for the payor authorization, the facility or specialist prior to the services being rendered by verifying coverage, obtaining authorization and communicating with receiving facilities
4. Tracks and manages all referrals by monitoring outstanding referrals at 30/60/90 day intervals and following up with patients if appointments are not kept
5. Applies knowledge of medical terminology and maintains up to date knowledge of insurance environment. Utilizes internal and external resources to seek knowledge about regulations regarding various payor sources
6. Collaborates with outside referral sources and other community resources. Maintains an updated list of community resources and networks with colleagues to develop additional referral sources
7. This position has frequent communications with patients, physicians, staff, and third party payers. The position must work with and understand the concepts of managed health care and be able to prioritize tasks within established guidelines with moderate supervision
MINIMUM QUALIFICATIONS
High school diploma/GED or equivalent working knowledge.
Possesses 1 year of direct patient interaction/experience in a medical, insurance, or healthcare related industry.
Knowledge of HIPAA regulations. Strong customer service focus and willingness to problem solve. Effective verbal and written communication skills and the ability to manage competing priorities. Must be proficient with commonly used office software.
Employees working at Banner Scottsdale Sports Medicine, second floor must possess an Arizona Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment.
PREFERRED QUALIFICATIONS
Previous knowledge of managed care concepts. Working knowledge of medical terminology and ICD-9 and CPT codes.
Additional related education and/or experience preferred.
EEO Statement:
EEO/Female/Minority/Disability/Veterans
Our organization supports a drug-free work environment.
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