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Summary

Sun Aug 20, 2017 - 5 weeks ago

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REFERRAL SPECIALIST - FFHC

**GENERAL DESCRIPTION/STATEMENT: **
Uses TAMC Standards of Behavior to demonstrate professionalism at all times with patients and co-workers. A team player is necessary for this position of variable skills, organization and an independent working environment. Fast paced setting requires independent thinking, ability and willingness to be flexible and adaptable to changes.
Referral Specialist will be supervised and managed by the Lead Referral Specialist and Practice Manager overseeing the practice. He/she will report Lead Referral Specialist, for assistance, questions, concerns, issues regarding responsibilities (see Essential Duties below).
**ESSENTIAL DUTIES:**
1. _Manages and monitors all prior authorizations/out-going & incoming referrals for the assigned departments(s) follow Medical Group Policy and Procedures._
2. _Works collaboratively on revenue cycle issues with clinical staff, providers, ancillary departments, and insurance carriers to complete work._
3. _Maintains working knowledge of inpatient vs. outpatient procedures._
4. _Maintains referral tracking documentation to determine that referral is complete._
5. _Maintains current knowledge of various insurance carrier processes necessary to obtain prior authorization; follows Prior Authorization Policy. Uses Medical Necessity Software to ensure insurance coverage and/or implements ABN process with patients as needed. _
6. _Assists with claim denials as assigned by Practice Manager._
7. _Does daily charge posting for the office and ensures that the charges posted are correct. Is Responsible for any corrections/UMR's, as assigned by the Manager._
8. _Makes recommendations for change to improve processes in accordance with TAMC mission statement and established goals._
9. _Provides Patient Assistance to patients without the ability to pay for necessary prescriptions and works with providers to ensure medication prior auths are completed as needed. _
10. _Ensures compliance with Medicare and third party payers' procedures._
11. _Maintain safety standards at all times and report safety issues immediately_
12. _Maintains mandatory education compliance._
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**OTHER RESPONSIBILITIES:**
1. Prepares reports as necessary.
2. On occasion may be assigned to work in another department other than primary.
3. Assist other staff and providers as required with special projects and requests.
4. May be required to cross train with H.S.A. staff to help with short term coverage. (ie lunch breaks)
**LICENSE REQUIREMENTS:**
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No license is required.
**AVAILABILITY REQUIREMENTS:**
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Weekdays, but may infrequently require some early morning and/or evening hours.
**EDUCATION, SKILLS, EXPERIENCE REQUIREMENTS:**
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? High school diploma or G.E.D;****
? Excellent organizational and communication skills;****
? Attention to detail at a high level;****
? Ability to work independently (self-motivated) ;****
? Ability to organize and prioritize work to meet deadlines;****
? Word processing/typing skills/telephone ****
? Clinical or coding experience preferred but not required****

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