THS POSITION IS FOR EMERSON LOCATION (UF health internal medicine)
Scope of the Job
This position is responsible for processing referral requests for all providers practicing within the clinic module and ensuring that when needed, referral/authorization numbers are obtained for these services.
Access to specialty and ancillary services is a key component of the satisfaction of our patients and referring providers. The responsibilities of this position are extremely important in meeting or exceeding customer satisfaction.
- Attends Referral training class and various referral system training classes within 1st month of employment
- Attends and actively listens and participates in the regularly scheduled Referral Coordinator meeting
- Process referrals for services requested by Providers within established guidelines, to include external referrals
- Obtains authorizations for referrals and schedules appointments as appropriate and within required timeframes
- Processes requests for additional referrals/authorizations when requested by providers
- Assures referrals are maintained within appropriate network or payer requirement
- Provides a standard of excellence as it relates to customer service and satisfaction for all customers.
- Communicates with all stakeholders, staff, providers, payers and patients as appropriate and per procedure
- Remains current on referral policies and procedures, payer requirements and Managed Care Matrix utilizing the various on-line resources
- Documents required information into the appropriate systems
- Maintains patient privacy
- Participates in performance improvement projects
- Participates as an active care team member in the coordination of patient care.
Performs routine CSR duties as required
Adheres to all regulatory requirements such as JCAHO, CLIA, HIPAA, etc.
Must be able to perform under stress when confronted with emergency, critical, or unusual situations.
Must be capable of dealing with periodic cyclical workload pressures and levels of responsibility.
Required to make independent judgments without supervision. Must be able to make generalizations, evaluations, or decisions based on sensory or judgmental criteria.
Must have the adaptability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure.
Requires the ability to work with people beyond giving and receiving instructions.
SKILLS, QUALIFICATIONS, AND REQUIRED EXPERIENCE
Knowledge of insurance plans and guidelines
Ability to obtain authorizations and pre-certifications from insurance plans
Excellent customer service skills
Ability to multitask in a fast paced environment
Ability to communicate effectively, both written and orally
Above average organizational skills
2 years experience in the field or in a related area
Minimum of 2 years customer service experience
Minimum of 2 years with third party payers (insurance carriers) using commonly used concepts, practices and procedures in the field
Computer experience required
Education and Certifications
High school diploma or GED equivalent required
ICD-9 and CPT coding experience preferred
Completion of a medical terminology course preferred
UFJPI is an Equal Opportunity Institution
# of Hires Needed