Referral Specialist Job at CHI Saint Joseph Medical Group
Overview
CHI Saint Joseph Medical Group now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI) and Dignity Health includes 275 providers delivering quality care to patients across 88 locations in central and eastern Kentucky. Our full service network delivers a variety of Primary Care Services including Family Internal Geriatric and Pediatric Medicine in addition to several specialties to deliver custom care based on the unique needs of our patients.
Responsibilities
The Referral Specialist works with patients requiring a referral, to ensure patient’s referral needs are fulfilled for specialty service office visits. Processes referrals, authorizations and pre-certifications for patients, to ensure timely reimbursement.
Expectations:
Qualifications
Required Education for Staff Job Levels
Required Minimum Knowledge, Skills and Abilities
PREFERRED Qualifications
CHI Saint Joseph Medical Group now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI) and Dignity Health includes 275 providers delivering quality care to patients across 88 locations in central and eastern Kentucky. Our full service network delivers a variety of Primary Care Services including Family Internal Geriatric and Pediatric Medicine in addition to several specialties to deliver custom care based on the unique needs of our patients.
Responsibilities
The Referral Specialist works with patients requiring a referral, to ensure patient’s referral needs are fulfilled for specialty service office visits. Processes referrals, authorizations and pre-certifications for patients, to ensure timely reimbursement.
Expectations:
- Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.
- Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter service, specialty care, etc.
- Coordinate flow of information between medical clinic and referral authorization department to secure a valid referral for clinic patient.
- Enter referrals, documents communications and action into the system, as appropriate.
- Notify physician(s) and patient when referral is denied, or if additional information is needed.
- Develop and maintain database of referral physician offices preferred by each physician within the clinic.
- Assist Practice Manager with complaint resolution and solutions related to patient referrals.
- Preform other duties as assigned by the Practice Manager or Physician.
Qualifications
Required Education for Staff Job Levels
High school diploma or equivalent.
Required Minimum Knowledge, Skills and Abilities
Knowledge of clinic referral and scheduling processes and billing/authorization requirements.- Knowledge of federal and state pay requirements, including Medicare. DSHS, HMO/PPO contracts.
- Ability to communicate effectively and to maintain strict confidentiality.
- Ability to respond to people and issues promptly and appropriately, to resolve problems.
- A team player who handles multiple projects simultaneously in a fast-paced environment.
- Possess a strong work ethic and a high level of professionalism.
PREFERRED Qualifications
Healthcare experience preferred.
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