Virginia Mason Franciscan Health brings together two award winning health systems in Washington state ? CHI Franciscan and Virginia Mason. As one integrated health system with the most patient access points in western Washington our team includes 18,000 staff and nearly 5,000 employed physicians and affiliated providers. At Virginia Mason Franciscan Health you will find the safest and highest quality of care provided by our expert, compassionate medical care team at 11 hospitals and nearly 300 sites throughout the greater Puget Sound region.

This job is responsible for working with patients requiring a referral to ensure the patients referral needs are fulfilled. Incumbent obtains and processes all referrals, authorizations and pre-certifications for patients requiring ancillary testing and/or surgical procedures to ensure timely reimbursement.
Incumbents are accountable for; 1) processing referral orders and gathering patient insurance eligibility information and obtaining pre-authorizations 2) coordinating patient appointments 3) distributing pre-visit instructional materials to patients, 4) providing cost estimate and benefits information and 5) coordinating the rental and/or purchase of medical materials and equipment. An incumbent is located either behind-the-scenes, interacting with patients on the phone or at the front desk, interacting with patients directly.

Responsbilities include:

Processes referral orders and/or pre-authorizations.
Ensures that insurance eligibility checks have been conducted on all referrals before the patient is seen, either by escalating to the Insurance Verifier, or by directly checking on eligibility.
Completes referrals and/or pre-authorization, before the patient is seen, for diagnostic testing, therapy, surgeries, procedures and specialty care according to requirements and patient preference.
Provides information to patients regarding their health care plan; interprets and communicates plan policies and procedures to employees, physicians and members (patients).
Provides patients with answers to billing and insurance clarification questions; obtains a cost estimate when requested and explains insurance benefit coverage to patient.
Notifies physician(s) and patient when referral is denied or if a second opinion or additional info is needed.
Updates the patients medical record as necessary. Copies/scans documents into correct location within electronic medical record.
May interact with referring clinic to ensure successful coordination of patient care.

Coordinates appointments and ancillary services.
Coordinates patient clinic visits based on authorized referral in accordance with established standards and procedures; gathers and documents insurance eligibility data, conducting routine verifications that can be done quickly during conversation; enters data in patients electronic medical record as appropriate.
Identifies patients requiring contact to confirm a referral appointment; contacts patient in accordance with established procedures.
Contacts and follows up with patients to reschedule a missed/cancelled appointment; documents reason(s) for no-show in accordance with established procedures; notifies management if patient has violated a policy and further action is required.
Responds to patient questions regarding routine billing and insurance matters.
Provides basic information in response to patient questions on billing and insurance matters; obtains a non-complex cost estimate when requested; refers questions regarding more complex cost estimates/benefits information to Financial Counselor.

Coordinates patient instructional/educational activities relevant to the patients referral.
Works with clinic team, patients and/or employers to ensure that patients receive adequate instructions and information regarding educational opportunities relevant to the patients referral; provides information to patients regarding their referral appointment and service for testing, financial policies, registration requirements, etc.
Provides patient with pre-visit prep materials; packages materials to correspond with type/nature of patient appointment and sends to patient in a timely manner.
Coordinates purchase of materials and/or the rental of medical equipment relevant to the patients referral.
Follows up with patients when equipment return is due.

Education/Work Experience Requirements:
Successful completion of an accredited medical terminology course(s) or equivalent on the job training, and one year of progressively responsible work experience that would demonstrate attainment of the requisite job knowledge/abilities. Work experience in patient scheduling/registration, insurance verification, referral coordination, financial counseling or related function is preferred.