This position is responsible for coordinating referral orders for a continuation of treatment, such as specialty services and diagnostic testing within a primary care practice. This position provides all pertinent clinical information needed for the payor authorization and the facility or specialist prior to the services being rendered. The position is responsible for tracking and managing all referrals with the intention and outcome to close any patient care gaps, along with providing documentation to promote team awareness.
Schedules appointments for specialty physician services and diagnostic testing per provider request and communicates with the patient on a timely basis for all scheduling requirements
Acts as a liaison between patients, providers and staff members for patients referral and follow up needs. Provides prompt and professional service for the patients by assisting in educating patient/family and assisting patients with external resources when needed.
Provides all pertinent clinical information needed for the payor authorization, the facility or specialist prior to the services being rendered by verifying coverage, obtaining authorization and communicating with receiving facilities
Tracks and manages all referrals by monitoring outstanding referrals at 30/60/90 day intervals and following up with patients if appointments are not kept
Applies knowledge of medical terminology and maintains up to date knowledge of insurance environment. Utilizes internal and external resources to seek knowledge about regulations regarding various payor sources
Collaborates with outside referral sources and other community resources. Maintains an updated list of community resources and networks with colleagues to develop additional referral sources
High school diploma/GED or equivalent working knowledge.
Possesses 1 year of direct patient interaction/experience in a medical, insurance, or healthcare related industry. Knowledge of HIPAA regulations. Strong customer service focus and willingness to problem solve. Effective verbal and written communication skills and the ability to manage competing priorities. Must be proficient with commonly used office software.
Previous knowledge of managed care concepts. Working knowledge of medical terminology and ICD-9 and CPT codes.
Additional related education and/or experience preferred.
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.
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