Referral Specialist
US-IL-Moline
careers
Req #: 170579
Type: Full Time Benefits
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Overview: Referral Specialist Monday-Friday 8:00AM-5:00PM Full Time Benefits As a Referral Specialist at UnityPoint Clinic, you'll play a pivotal role in managing the seamless coordination of patient referrals within our healthcare ecosystem. You will be entrusted with overseeing the entire referral process, ensuring a smooth transition from the initial receipt of the referral from providers to effective communication with patients. This position requires meticulous attention to detail, excellent organizational skills, and a commitment to delivering exceptional customer service to our clinical teams and patients alike. Responsibilities: Coordination of Patient Appointments & Authorizations * Manage and oversee the entirety of the patient referral process, from intake to completion, ensuring accuracy and timeliness at each stage. * Schedule visits with specialists or outpatient services, aligning with patient preferences and provider recommendations. * Complete thorough documentation within the Electronic Medical Record (EMR), maintaining precise and up-to-date records of all referral-related information. * Communicate effectively and efficiently with referring offices, specialists, and patients to relay pertinent referral information, ensuring clarity and comprehension on all sides. * Collaborate closely with clinical teams to streamline processes and optimize patient care delivery. * Uphold the highest standards of customer service and professionalism, both internally within our clinic and in interactions with external stakeholders, demonstrating professionalism and empathy at all times. * Support the maintenance of standard processes and procedures for workflows, payer specific requirements, and external referral partner information. * Actively participate as a supportive team member, contributing positively to a collaborative work environment and fostering a culture of mutual respect and teamwork. Correspondence with Patients * Communicates to patient about scheduled tests/procedures, appointment details, and insurance coverage via appropriate communication channels. * Notifies patient of any instructions and explanations of tests/procedures to patients per protocols. * Utilizes exemplary customer service skills with every patient interaction. Obtain Pre-Certifications and Prior Authorizations * Obtain pre-certifications or prior authorizations as required for referrals. * Collaborate closely with healthcare providers and insurance companies to obtain necessary prior authorizations and pre-certifications for referred services or treatments. * Navigate insurance protocols and policies to ensure compliance with specific requirements for different procedures or specialist visits. * Maintain up-to-date knowledge of insurance coverage and authorization processes, staying informed about any changes or updates in insurance regulations that may affect the referral process. * Support the maintenance of standard processes and procedures for workflows, payer specific requirements, and external referral partner information. * Advocate for patients when dealing with insurance companies to ensure timely approval of necessary treatments or services, addressing any issues that may arise during the authorization process. * Document and track authorization statuses meticulously within the Electronic Medical Record (EMR) system, ensuring accuracy and completeness of all related information. * Communicate professionally and effectively with healthcare providers, patients, and insurance representatives to convey authorization status updates and requirements, ensuring all parties are informed and aligned throughout the process. Qualifications: Education * High School diploma or equivalent. Experience * 2-3 years previous experience in medical field. * Basic knowledge of medical terminology, anatomy, and physiology. License(s)/Certification(s) * Valid driver's license when driving any vehicle for work-related reasons. Knowledge/Skills/Abilities * Outstanding interpersonal and communication abilities, both written and verbal and ability to interact effectively with internal and external customers. * Excellent organizational skills with an acute attention to detail. * Ability to work collaboratively within a multidisciplinary team environment. * Writes, reads, comprehends, and speaks fluent English. * Multicultural sensitivity. * Microsoft Office - basic computer skills. * Critical thinking skills using independent judgment in making decisions. * Ability to understand and apply guidelines, policies, and procedures.
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