LifeBridge Health, Inc. REFERRAL SPECIALIST-PPO in Frederick, Maryland
Position Summary: Prepares and intiates patient referrals necessary for specialty services in accordance with departmental and payor requirements. Maintains log to demonstrate provider referral patterns. Works proactively to optimize patient satisfaction and reimbursement opportunties. Essential Functions: Process Referrals Prepares and initiates referrals, obtains and tracks authorizations, and follows up on outstanding referrals. Tasks: Verifies patient coverage for specific benefits. Answers incoming calls regarding referrals. Completes referrals initiated by the primary care physician in a timely and accurate manner; encloses any pertinent information from patient's chart and contacts patient when referral is complete. Obtains authorizations for scheduled procedures and admissions; assures compliance; coordinates with managed care payors. Maintains, prioritizes and monitors work flow to ensure authorizations and referrals are completed in a timely and accurate manner. Tracks and ages referrals; follows up on those outstanding with appropriate person. Completes and submits accurate monthly statistic reports. Provides specialist information to the patient to allow them to make their own appointment according to the availability. Patient Services Services the needs of patient in the Medical Office. Tasks: Schedules patients for tests and procedures. Explains referral process to patient. Works closely with staff and physicians regarding patient care issues concerning referrals. Serves as the liaison between payors and insurers, physicians and other Hospital departments.
Formal working knowledge; equivalent to an Associate's degree