Website SAC Health System
ESSENTIAL FUNCTIONS AND DELIVERABLES:
- Processes incoming referral requests daily.
- Reviews referral orders for accuracy of codes and supporting documentation.
- Receives, processes and verifies accuracy of authorizations.
- Receives and processes specialty notes to primary care physician to facilitate on-going authorizations for continued care.
- Serves as liaison and authorization resource to clinic staff, outside medical groups and patients.
- Knowledgeable and familiar with insurance policies, referral, and authorization processes. Works with insurance companies / managed care groups to ensure pre-visit information is sent to patients as needed.
- Utilizes exceptional customer service skills in performing duties and assists with problematic referral and authorization process. Ability to resolve problems in a timely manner.
- Recommends improvements to department processes as appropriate.
- Contacts insurance company(s) to verify patient eligibility and benefits.
- Contacts patients as needed to update demographics. Informs patients/guarantors of their financial responsibility for scheduled services.
- Informs patients and/or clinic the staff of any insurance problems affecting future services.
- Develops and maintains professional working relationships with outside providers, vendors and insurance groups involved in the referral process. Ability to work cohesively with all other SACHS departments.
- Maintains an accurate and up-to-date tracking system for referrals and authorizations.
- Maintains current referral forms and insurance resource materials.
- Monitors and reports productivity statistics data to supervisor on a weekly basis.
- Performs general clerical duties including, but not limited to, typing, filing, answering the telephone, monitoring incoming faxes/mail and assisting patients/providers at a service window or patient exam room.
- Performs other duties as assigned.
- Assists supervisor with special projects, as requested
- Must be able to adhere to the Attendance policy and procedure.
- Ability to collaborate, teach, support and function in a teaching organization that builds, coaches and embraces interns and residency programs. Must demonstrate a passion for the team and have the ability to consistently work with rotating doctors, residents and interns, while continuously building a trusting, safe, patient-centered workplace.
- Demonstrate the ability to be culturally sensitive and respect diversity, work effectively and with individuals of different cultures and socioeconomic status; Passion for service.
Education and Experience:
- High school diploma or equivalent
- 3-5 years of customer service, or Referral experience in the medical field
- Medical terminology required
- As a requirement of this position, you must receive EPIC certification for the module you have been hired into.
- FQHC outpatient clinic
- Bilingual English/Spanish