Referral Representative - Pediatric Contact Center

Job Summary:

Obtain referrals, pre-certifications and prior-authorizations via internet, faxing forms, and/or making calls to insurance companies. Schedule all procedures and the necessary pre-certification. Schedule all diagnostic tests and all necessary pre-certification. Follow up on all scheduled referral appointments, diagnostic testing, and procedures; confirming scheduled date/time, and patient notification. Document all referrals, procedures, and diagnostic tests in the appropriate log books and retain the information for review. Obtain Prior Authorizations for medications not included on patient formularies. Verify patient insurance 24hours prior to scheduled appointment time and troubleshoot / eliminate any patient eligibility issues identified. Act as back-up for the PSR position(s). Perform general office duties such as data entry, filing, etc. May be responsible for Invision/Flowcast registration and other functions as designated. Perform any other duties as directed.

This position is involved in a team-based approach to care. Team members are trained to meet the highest level of function for their role as per the State of Tennessee/Georgia guidelines. Is trained and assigned (as per their role and responsibilities) to coordinate care for patients and is trained and assigned to support patients/families/caregivers in self-management, self-efficacy and behavior change. Is trained and assigned (as per their role and responsibilities) to manage the practices' patient population. Participates in the practice's quality improvement process and performance evaluation.

Education Required:

High school diploma and training for computer competency.

Preferred:

Medical terminology course desired

Experience Required:

Must be proven to possess excellent communication skills and be able to interface appropriately with others of multiple ethnic and educational backgrounds. Highly organized, detail-oriented, self-starter with strong math skills who can function efficiently and professionally with all customers, both internal and external, in a demanding environment. Clerical experience and/or hospital experience a requirement. Always poised, courteous, pleasing personality and great telephone etiquette. Work requires knowledge of general business principles in a related healthcare or business field, or equivalent combination of education and experience. Previous experience with appointment scheduling, referrals, patient registration and data entry. Also will assist with other office functions such as chart preparation, as needed.

Preferred:

Prior Centricity/ Flowcast/Invision/SMS experience desirable.

Position Requirement(s): License/Certification/Registration

Required:

N/A

Preferred:

N/A

Department Position Summary:

Interaction with third party payers and other departments; and communicating with people of a broad socio-economic mix. Strong organizational skills and a commitment to teamwork are essential. Will work closely in a clinical setting involving some stressful situations, personal flexibility; moderate sitting, standing, stooping, bending and moderate work at portable computers required. Will work closely with other physician offices to keep abreast of any new updates or changes with regards to scheduling, registration and referrals.

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