Referral coord
Company Name:
Weeks Medical Center - DHA
Position Summary
Referrals Specialist has a primary responsibility to process referrals, prior authorization as requested from primary care physicians and assistance/backup to the Scheduling Staff. The Referral Specialist also maintains and updates eCW provider schedules under direction of the office administrative staff.
Qualifications
High school education or equivalent with special emphasis in business and computer courses.
Minimum of two years previous healthcare office experience.
Computer literate; knowledge of Microsoft Office (Word, Excel required).
Good spelling and grammar knowledge.
Medical Terminology basic knowledge required.
Essential Functions of the Job
Required skills and competencies. Has competency checklist been completed with all competencies met (i.e. job skills / knowledge, equipment knowledge).
Accurately and timely create and/or process referrals, diagnostic imaging orders and prior authorizations, documenting thoroughly in the notes section.
Standard: timestamp is added to a high priority referral within 4 hours of receipt during the work hours; routine referral has timestamp acknowledging receipt within 48 hours of receipt. No more than 3 delays in a 12 month period.
Audit method: random audits of referrals processed.
Responsible for processing all types of referrals (Incoming by non-WMC providers to a WMC specialist; Outgoing by WMC providers, to WMC specialist or outside providers).
Confirm fields are complete and obtains missing information.
Confirm benefits and eligibility under their insurance plans.
Determine if a formal referral from the patient?EUR(TM)s PCP is required.
Notify financial counselor if indicated per protocol.
Process prior authorization with help of clinical staff if needed.
Responsible for following up on claims which denied due to the referral process.
Change visit status to appropriate code and assign referral per established protocol to ensure that an appointment is scheduled and that the PCP is notified.
Handles all telephone calls in a timely, professional, courteous, and helpful manner, avoiding voice-mail whenever possible. Is able to enter telephone encounters into EMR system and follow through as appropriate.
Responsible as backup as a scheduler, scheduling appointments following visit rule guidelines, referring calls through telephone encounter to nursing staff or providers as necessary. Appointments include but are not limited to primary care, specialty clinics, and urgent/emergency patients to be seen same day. Verifies accuracy of patient demographic and insurance information and updates patient information in the computer system.
Accurately and timely maintains and updates provider schedules in eCW to reflect blocks, temporary and permanent changes. To be completed within 24 hours of receipt of request unless otherwise specified by requester.
Standard: no more than 3 delays in a 12 month period.
Audi method: no complaints received of delay in making the change or in inadequately verifying the change was made correctly.
Other duties as assigned.Estimated Salary: $20 to $28 per hour based on qualifications.
Weeks Medical Center - DHA
Position Summary
Referrals Specialist has a primary responsibility to process referrals, prior authorization as requested from primary care physicians and assistance/backup to the Scheduling Staff. The Referral Specialist also maintains and updates eCW provider schedules under direction of the office administrative staff.
Qualifications
High school education or equivalent with special emphasis in business and computer courses.
Minimum of two years previous healthcare office experience.
Computer literate; knowledge of Microsoft Office (Word, Excel required).
Good spelling and grammar knowledge.
Medical Terminology basic knowledge required.
Essential Functions of the Job
Required skills and competencies. Has competency checklist been completed with all competencies met (i.e. job skills / knowledge, equipment knowledge).
Accurately and timely create and/or process referrals, diagnostic imaging orders and prior authorizations, documenting thoroughly in the notes section.
Standard: timestamp is added to a high priority referral within 4 hours of receipt during the work hours; routine referral has timestamp acknowledging receipt within 48 hours of receipt. No more than 3 delays in a 12 month period.
Audit method: random audits of referrals processed.
Responsible for processing all types of referrals (Incoming by non-WMC providers to a WMC specialist; Outgoing by WMC providers, to WMC specialist or outside providers).
Confirm fields are complete and obtains missing information.
Confirm benefits and eligibility under their insurance plans.
Determine if a formal referral from the patient?EUR(TM)s PCP is required.
Notify financial counselor if indicated per protocol.
Process prior authorization with help of clinical staff if needed.
Responsible for following up on claims which denied due to the referral process.
Change visit status to appropriate code and assign referral per established protocol to ensure that an appointment is scheduled and that the PCP is notified.
Handles all telephone calls in a timely, professional, courteous, and helpful manner, avoiding voice-mail whenever possible. Is able to enter telephone encounters into EMR system and follow through as appropriate.
Responsible as backup as a scheduler, scheduling appointments following visit rule guidelines, referring calls through telephone encounter to nursing staff or providers as necessary. Appointments include but are not limited to primary care, specialty clinics, and urgent/emergency patients to be seen same day. Verifies accuracy of patient demographic and insurance information and updates patient information in the computer system.
Accurately and timely maintains and updates provider schedules in eCW to reflect blocks, temporary and permanent changes. To be completed within 24 hours of receipt of request unless otherwise specified by requester.
Standard: no more than 3 delays in a 12 month period.
Audi method: no complaints received of delay in making the change or in inadequately verifying the change was made correctly.
Other duties as assigned.Estimated Salary: $20 to $28 per hour based on qualifications.
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