What are the responsibilities and job description for the Referral Specialist (Potential Remote Opportunity) position at Trinity Health - IHA?
POSITION DESCRIPTION:
This position is responsible for all aspects of the referral process, which may vary depending on practice/department specialty. May perform Medical Receptionist duties as necessary.
ESSENTIAL JOB FUNCTIONS:
- Educates patients and staff with pertinent referral and insurance information.
- Obtains pre-certifications and insurance authorizations for medical procedures.
- Generates referral information for physicians, patients and health plans.
- Acts as a liaison among providers, patients and health plan administrators.
- Relays clinical information to health plan case managers for special procedure pre-certification and out-of-plan or out-of-network referrals; monitors authorizations or denials and follows up as necessary.
- Communicates referral status to patients and physicians; ensures that referrals have been processed accurately and in a timely manner to coincide with patient treatment plan.
- Assists patients in scheduling appointments with specialists, resolving billing discrepancies and any other referral issues.
- Supports other offices, attends required meetings and training, and participates in committees as requested.
- May perform Medical Reception duties as necessary.
- Assists with special projects and assumes additional duties as assigned.
ORGANIZATIONAL EXPECTATIONS:
- Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of both IHA and Trinity Health.
- Must be able to work effectively as a member of the reception team.
- Successfully completes IHA’s “The Customer” training and adheres to IHA’s standard of promptly providing a high level of service and respect to internal or external customers.
- Maintains knowledge of and complies with IHA standards, policies and procedures.
- Maintains complete knowledge of office services and in the use of all relevant office equipment, computer and manual systems.
- Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines
- Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences.
- Uses resources efficiently.
- Monitors, organizes and keeps work area and waiting room neat.
MEASURED BY:
Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.
ESSENTIAL QUALIFICATIONS:
EDUCATION: Undergraduate degree or Associate’s degree in health care or a related field and specialized training or equivalent combination of education and experience.
CREDENTIALS/LICENSURE: None
MINIMUM EXPERIENCE: 4 years’ experience with insurance referrals, prior authorization or other relevant medical office experience.
POSITION REQUIREMENTS (ABILITIES & SKILLS):
- Knowledge of medical terminology and procedures at the level needed to perform responsibilities.
- Proficient knowledge of major health plans and insurance processes.
- Excellent written (legible), verbal and face-to-face communication skills, including ability to effectively explain relevant insurance information to patients, as well as communicate with insurance plans and internal customers. Proper phone etiquette.
- Proficient/knowledgeable in patient care procedures and organizational policies related to position responsibilities.
- Service-oriented; responsive to customer needs and courteous in approach.
- Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, NextGen, Microsoft Word /Excel/Outlook, intranet and computer navigation.
- Ability to compute mathematical calculations.
- Ability to work independently and collaboratively in a team-oriented environment; displays professional and friendly demeanor.
- Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, patients, family members, vendors, outside customers and couriers.
- Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.
- Good organizational and time management skills to effectively juggle multiple priorities and time constraints.
- Ability to exercise sound judgement and problem-solving skills.
- Ability to handle patient and organizational information in a confidential manner.
- Ability to travel to other office/practice sites and meeting and training locations.
- Successful completion of IHA competency-based program within introductory and training period.
MINIMUM PHYSICAL EXPECTATIONS:
- Physical activity that often requires keyboarding, filing and phone work.
- Physical activity that often requires extensive time working on a computer.
- Physical activity that sometimes requires walking, standing, bending, stooping, reaching, and/or twisting.
- Physical activity that sometimes requires lifting, pushing and/or pulling under 30 lbs.
- Specific vision abilities required include close vision, depth perception, peripheral vision and the ability to adjust and focus.
- Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
- Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.
MINIMUM ENVIRONMENTAL EXPECTATIONS:
This job operates in a typical office environment with some exposure to contagious diseases/viruses. It requires significant interaction with people (many of whom are scared, hurt and/or ill) which can be stressful and result in competing priorities.
Location: Central · Service Center - Specialty
Schedule: Full Time, 8am-430pm
