Referral Rep – Beacon Health System – South Bend, IN

Reports to the Manager/Director and works under the direction of the Office Supervisor. Under general supervision and according to established policies and procedures. Responsibilities include Receptionist duties as well as scheduling specialty and/or diagnostic procedures, knowledge of ICD-10, CPT and online Authorizations. Assists in coordinating health care services to a large outpatient client population. Verifies insurance eligibility when appropriate for the physician office and/or member.

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Performs routine reception and clerical duties in accordance with established policies and procedures by:

• Receiving and greeting patients and visitors and checking in patients for their appointments.
• Receiving telephone calls, taking and relaying messages accurately.
• Obtaining information from the patient to accurately complete the patient record for payment information, computer input, etc.
• Maintaining patient files, charts, and records.
• Maintaining good rapport and cooperative working relationship with all members of the medical offices, other medical offices, hospital services, and community agencies.
• Maintaining technological competencies, organization, and neatness in the work area.
• Completing all mandatory in-services in required time frame.
• Assisting co-workers as needed.
• Acting as liaison between provider offices, physicians, health plans and other department to ensure high quality customer service are being delivered.

Performs Referral duties in accordance with established policies and procedures by:

• Performing online insurance eligibility/authorizations, and scheduling diagnostic/specialty referrals.
• Resolving re-certification, registration and case-related concerns prior to a patient’s appointment
• Gathering pertinent information from insurance carriers, financial counselors, and other ancillary staff to make certain the patient’s financial obligations for services provided.
• Providing support to clinical staff in order to facilitate the administrative components of clinical referrals for various services.
• Acting as a liaison between hospitals, physicians, health plans, vendors, and patients, or other referral sources.
• Verifying insurance coverage and obtains authorizations if needed from insurance coverage.
• Entering referrals and documents communications, actions, and other data in an information system
• Evaluating current processes for enhancement and make necessary recommendations.

Patient care duties, as directed by the physician or nurse, by:

• Interpreting physician’s instructions to patients and providing instruction to patients.
• May schedule imaging and diagnostic procedures.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department.

• Attending required meetings and participating in committees as requested.
• Enhancing professional growth and development through in-service meetings and educational programs as approved.
• Completing other job-related duties and projects as assigned.

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Commitment to Beacon’s six-point Operating System, referred to as The Beacon Way:

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

Education and Experience

• The knowledge, skills and abilities as indicated are normally acquired through the successful completion of a high school diploma or equivalent; Previous medical office experience, ICD-10, CPT, online insurance eligibility/authorizations, and specialty/diagnostic referral experience preferred.

Knowledge & Skills

• Demonstrates well developed communication skills to communicate effectively and clearly to a variety of internal and external contacts.
• Knowledgeable in ICD-10, CPT, online insurance eligibility/authorizations, and scheduling diagnostic/specialty referrals.
• Knowledge of Allscripts, Cerner, referral database, excel, word, outlook, and net learning.
• Knows and adheres to all laws and regulations pertaining to patient health, safety and medical information.
• Demonstrates analytical skills necessary to solve patient problems and interpret data.
• Promotes collaboration and innovation in the clinical services to ensure an interdisciplinary approach to improving health care delivery and the quality of patient care.
• Must be tactful in handling patient problems often of a highly personal and confidential nature.
• Must be able to maintain professionalism during frustrating interpersonal situations.

Working Conditions

• Assigned hours within your shift, starting time, or days of work are subject to change based on departmental and/or organizational needed.
• May need to travel to other Beacon locations.
• Understands and strives for providing excellent customer service.
• Ability to adjust communication skills to the level of the patient.
• Works under direct supervision, but requires independent critical thinking skills and extensive problem solving skills.

Physical Demands

• Requires the physical ability and stamina to perform the essential functions of the position.