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Tucson , AZ 85756
Posted 3 months ago
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Referral Specialist Managed Care
This is a Full-Time, Benefits Available, CONTRACT assignment, expected to last around 6 months, or longer!Referral
Referral Specialist Background:
- Handles incoming requests for patient placement, referrals for new orders and refills, and/or requests for services.
- Receives and verifies requests and referrals, initiates insurance verification and gathers all information necessary for pre-certifications, authorizations, and certificates of medical necessity, while ensuring that each patient meets admission criteria.
- Provides on-going follow-up of requests up to, and following, patient discharge.
- Builds referrals using information in patient medical record to provide minimum data necessary to coordinate patient services.
- Provides verbal and written instructions to patients, families, and coordinating resources regarding provision of products and services, reimbursement and patient financial responsibility.
- Records patient intake and insurance information and authorization requirements and notes in the computer systems.
- Coordinates requested services, products, and referrals with pharmacy warehouse, clinical staff, as well as service and equipment providers, as appropriate.
- Facilitates problem solving with patients, hospitals, providers, referral sources, insurance companies, and clinical staff.
- Assists in the maintenance and communication of changing payer and referral source information specific to coordination of patient needs.
- Requires an education level of at least a high school diploma or GED.
- Prefer 1-2 years customer service experience, including some phone support roles.
- Must have a working knowledge of medical terminology and have familiarity with hospital operations
- Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
- Knowledge of health care delivery system, Medicaid/Medicare and related state programs is a significant plus.
- Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.