Referral Representative

Referral Representative

The Referral Representative processes insurance pre-authorization for primary and specialty service office visits and testing. Receives and gathers pertinent information from patients, providers, insurance carriers, and other staff to confirm the patients financial obligations for services. Acts as liaison between clinical staff, health plans, providers and patients to obtain insurance authorizations acting as the patient advocate in this circumstance. Verifies insurance coverage and obtains required authorization when necessary. Documents referral information, communications, actions and other data in electronic medical information systems to communicate to other staff a patients authorization progress.

Essential Functions

• Administrative departmental support, including processing into and through electronic medical records internal, external, and outbound referrals while assembling, researching, and triaging information about patient demographics, insurance, and medical needs. Maintains ongoing tracking and appropriate detailed documentation of referrals to promote team awareness and ensure patient safety.
• Follows regulatory requirements as defined by provider or specialty department to route inbound referral appropriately. Including appropriate documentation, imaging, or any other requirements while maintaining Intermountain standards for adding and scanning required information into electronic medical records.
• Liaison between patient, clinic, and insurance carrier to set details related to upcoming visit with Intermountain providers or scheduled procedures prior authorization requirements. Coordinates provider peer to peer interactions as it pertains to obtaining insurance approvals. Generates cost estimates for services as it relates to office visits and in-office testing; directs patients to financial counseling resources when appropriate.
• Contacts insurance company representatives or their contracted review organizations to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis, and prognosis. Assumes the advocate role on the patients behalf with the insurance carrier to ensure approval of necessary services for the patient in a timely fashion.
• Multiple partnerships with Patient Service Representatives and Clinical Staff for effective pre-registration and pre-visit preparation as needed. Also collaborates with Payer Relations to provide the required documentation relating to any denial or appeal information needed. All other duties as needed.
• Utilization of different insurance platforms and medical records systems according to department protocols to include accurate data entry and retrieval of information for reporting purposes.
• Meets performance standards, volume metrics while aligning with mission, vision, and values.

Skills

• Detail-Oriented
• Medical Terminology
• Customer Service
• Medical Records Management
• Critical Thinking
• Researching
• Communication
• Documenting

Minimum Qualifications

• Have a level of computer literacy that ensures accuracy and timeliness.
• Demonstrated ability to work well with coworkers and patients.
• Ability to collaborate with multiple teams.
• Skill to write clearly and professionally.
• Be thorough, precise and detail oriented.
• Knowledgeable in navigating Microsoft systems (Word, Outlook, Excel, OneNote).

Preferred Qualifications

• Experience with electronic medical records (EPIC).
• CNA, MA, EMT or healthcare or health plan experience.
• Referral coordination experience.
• Medical terminology knowledge.
• Bilingual (Spanish preferred)

Physical Requirements

• Ongoing need for employee to see and read information, labels, assess patient needs, operate monitors, identify equipment and supplies.
• Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations.
• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use and typing for documenting patient care, accessing needed information, medication preparation, etc.
• Expected to lift and utilize full range of movement to transfer patients. Will also bend to retrieve, lift, and carry supplies and equipment. Typically includes items of varying weights, up to and including heavy items.
• Need to walk and assist with transporting/ambulating patients and obtaining and distributing supplies and equipment. This includes pushing/pulling gurneys and portable equipment, including heavy items. Often required to navigate crowded and busy rooms (full of equipment, power cords on the floor, etc.)
• May be expected to stand in a stationary position for an extended period of time.
• For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Location: Foothills Medical Office Bldg

Work City: Wheat Ridge

Work State: Colorado

Scheduled Weekly Hours: 40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$18.81 - $27.45