Referral and Insurance Specialist

Ranken Jordan is the country's first pediatric bridge hospital. Inpatients and outpatients with complex medical conditions, injuries and illnesses come to our one-of-a-kind facility from throughout the region to get better faster and prepare for the transition back to home.

We are looking for amazing new TEAM MEMBERS like you!

A Peek Behind the Room Divider:

• Founded in 1941 by Mary Ranken Jordan who implored her staff to "...consider the children, first, in all that we do." These words still guide every employee, every day.
• Our guiding mission is to help kids and their families' transition from hospital to home. That means we practice world-class pediatric medicine to treat the symptoms but we also train parents and caregivers to provide a high-level of care at home so patients continue to progress after discharge
• "Care Beyond the Bedside" means that our kids receive their therapies and rehab away from their rooms and out of their beds as much as 70% of the day. The rest of the time, they are playing just being kids in our state-of-the-art facility designed to inspire children!

Job Summary

The Outpatient Referral and Insurance Specialist is responsible for ensuring the effective management of all incoming referrals for outpatient services and the transition of inquiries to the appropriate service lines within Ranken Jordan. Responsible for entering patient information into the electronic medical record (EMR) timely and accurately. Responsible for verification of all insurances, obtaining pre-certifications, authorizations, and benefit information. Responsible for up-front and previous balance collections as needed and performing job duties in accordance with the policies and mission of Ranken Jordan Pediatric Bridge Hospital.

Duties and Responsibilities:

1. Receiving and reviewing OP service referrals, transitioning inquiries to appropriate service lines. (25%)
2. Verification and documentation of insurance information for all federal and commercial plans; in/out of network benefits and options prior to initial date of service and monthly for recurring outpatients. (25%)
3. Determine patient's financial responsibilities as indicated by insurance and accurately document all findings in the EMR. Up-front collection of co-pays, deductibles, and co-insurances as needed. Referrals to financial services as needed for financial assistance. (25%)
4. Works closely with the OP Therapy Manager and the OP Coordinator to optimize scheduling and workflow. As-sists with various other duties as assigned, including but not limited to, assist in processing appeals for additional services (extended stays, visits, authorization extension, letter of medical necessity) and referrals to additional re-sources when necessary. Coverage for OP Coordinator as needed. Assist in the development, organization and maintenance of role specific documents, policies, and tools. (25%)

QUALIFICATIONS:

• The OP Referral and Insurance Specialist must have strong communication and customer service skills; excellent organizational and time management skills; the ability to prioritize multiple tasks; work independently; demonstrated clerical and organizational skills; knowledge of medical terminology; and proficiency with the MS Office suite required.
• Previous experience with admission and benefit eligibility verification processes preferred.
• Requires extensive time performing on-line verification and authorization requests. In addition, may require extended periods on phone performing insurance verification and authorization requests.

PHYSICAL DEMANDS:

These include stooping, kneeling, crouching, reaching, grasping, pulling, pushing, standing, carrying, and lifting light loads (up to 35 lb.).