Referral Specialist

Banner Health•Mesa, AZ

About The Position

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. CORE FUNCTIONS 1. 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 2. 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. 3. 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 4. 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 5. 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 6. 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 7. This position has frequent communications with patients, physicians, staff, and third party payers. The position must work with and understand the concepts of managed health care and be able to prioritize tasks within established guidelines with moderate supervision Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day. NOTE: The core functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager. SUPERVISORY RESPONSIBILITIES DIRECTLY REPORTING None MATRIX OR INDIRECT REPORTING None TYPE OF SUPERVISORY RESPONSIBILITIES N/A Banner Health Leadership will strive to uphold the mission, values, and purpose of the organization. They will serve as role models for staff and act in a people-centered, service excellence-focused, and results-oriented manner. PHYSICAL DEMANDS/ENVIRONMENT FACTORS OE - Typical Office Environment: (Accountant, Administrative Assistant, Consultant, Program Manager) Requires extensive sitting with periodic standing and walking. May be required to lift up to 20 pounds. Requires significant use of personal computer, phone and general office equipment. Needs adequate visual acuity, ability to grasp and handle objects. Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone. May require off-site travel

Requirements

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.

Nice To Haves

Previous knowledge of managed care concepts.
Working knowledge of medical terminology and ICD-9 and CPT codes.
Additional related education and/or experience preferred.

Responsibilities

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
This position has frequent communications with patients, physicians, staff, and third party payers.
The position must work with and understand the concepts of managed health care and be able to prioritize tasks within established guidelines with moderate supervision Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards.
Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.