Arranges referral appointments for specialists utilizing managed care guidelines and practices. Maintains working knowledge of, and adheres to compliance with, Medicare, Medicaid, and managed care regulations.
1. Arranges referrals as indicated by the provider, utilizing proper insurance referral guidelines and CPT, ICD9 and HCPCS coding. May be required to send necessary lab and ancillary reports.
2. Verifies insurance information, current PCP, and medical necessity for the referral. Obtains authorization for release of medical records.
3. Obtains insurance pre-certification and authorization as required by the various insurance plans. Notifies the ordering provider of any conflict or delay in scheduling.
4. May schedule testing, make necessary appointments, document in the patient's chart and notify the patient of the appointment and necessary special instructions.
5. Pulls and retrieves files as required. Routes charts back to dictation area or file as indicated.
6. Answers telephones, routes messages and redirects as necessary.
7. Maintains referral log and verifies that patient completed appointment; verifies receipt of specialists consult notes and/or follows up with specialist if needed.
8. Follows the CHRISTUS Physician Group guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
9. Maintains strict confidentiality.
10. Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the CHRISTUS Mission.
11. Maintains established CHRISTUS Physician Group policies, procedures, objectives, quality assurance, safety, environmental and infection control.
12. Implements job responsibilities in a manner that is consistent with the CHRISTUS Mission and Code of Ethics and supportive of CHRISTUS Physician Group's cultural diversity objectives.
13. Supports and adheres to CPG Service Guarantee.
14. Performs other related work as required.