Referral Center Representative at UnityPoint Health

West Des Moines, Iowa, United States -

Full Time

Start Date

Immediate

Expiry Date

14 May, 26

Salary

0.0

Posted On

13 Feb, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Referral Coordination, Appointment Scheduling, Insurance Pre-authorizations, Accurate Documentation, EMR Systems, HIPAA Compliance, Patient Registration, Insurance Verification, CPT Coding, ICD-10 Coding, Prior Authorization Requirements, Workflow Optimization, Organizational Skills, Customer Service, Critical Thinking, Medical Terminology

Industry

Description

Overview UnityPoint Clinic Referral Center Representative Monday-Friday 8 HR shift between 7:00AM-6:00PM, OR 4 day 10 HR shift between 7:00AM-6:00PM Full Time Benefits Why UnityPoint Health? At UnityPoint Health, you matter. We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members. Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in. Here are just a few: Expect paid time off, parental leave, 401K matching and an employee recognition program. Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members. Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family. With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together. And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience. Find a fulfilling career and make a difference with UnityPoint Health. Responsibilities The Referral Center Representative is responsible for coordinating patient referrals, scheduling specialty exams, obtaining insurance pre-authorizations, and ensuring accurate documentation to ensure timely and accurate healthcare access. The role acts as a liaison between patients, healthcare providers, and third-party payers to facilitate seamless communication and care coordination. The role also supports administrative tasks, maintains compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations, and enhances workflow efficiencies through referral tracking and quality improvement initiatives. Referral Coordination & Care Support• Works on patient referrals by coordinating appointment scheduling and ensuring the timely and accurate processing of referral requests, initiating referrals within 24 hours on business days, and documenting all stages in Electronic Medical Records (EMR) systems.• Coordinates and schedules specialty exams, diagnostic tests, and outpatient services as needed, ensuring proper authorization and documentation.• Obtains and documents insurance pre-authorizations and approvals from Third-Party Payers (TPP) for services as required.• Tracks and monitors referrals, ensuring proper documentation and follow-ups for injury cases, and maintains accurate referral reports for management.Acts as a liaison between patients, providers, employers, insurance companies, attorneys, and healthcare facilities to ensure seamless communication, care coordination, and timely notification of appointments and procedure instructions.Administrative & Compliance Support• Monitors and distributes incoming faxes, voicemails, and messages, forwarding them to appropriate personnel as required.• Completes necessary forms and requisitions for referrals and diagnostic testing, ensuring accurate Current Procedural Terminology (CPT) / International Classification of Diseases, 10th Revision (ICD-10) coding for billing and insurance purposes.• Maintains current knowledge of payer-specific prior authorization requirements, attending virtual workshops and reviewing updates from insurance providers.• Registers patients, verifies demographic and insurance information, and assists scheduling of office staff to optimize patient flow.• Supports quality improvement initiatives by tracking referral trends, identifying delays, and implementing workflow optimizations.• Ensures adherence to the Health Insurance Portability and Accountability Act (HIPAA) regulations, maintaining patient confidentiality while handling sensitive information. Qualifications Education HS Diploma Knowledge, Skills, Abilities, and Other Administrative Support Ability to provide general administrative support, including scheduling, maintaining departmental records, and coordinating team activities.Patient Registration & Scheduling Proficiency in assisting patients with check-in, check-out, appointment scheduling, and follow-ups while ensuring accuracy and efficiency.Medical Terminology & Coding Knowledge Understanding of International Classification of Diseases (ICD)-9/10, Current Procedural Terminology (CPT) coding, anatomy, physiology, and disease processes to support referral documentation and insurance processing.Medical Billing & Insurance Procedures Basic knowledge of medical billing, insurance documentation, and reimbursement processes.Regulatory & Compliance Knowledge of Healthcare laws and patient rights, including HIPAA and informed consent, safety standards and emergency protocols.Office Software Proficiency Knowledge of office software (e.g., Microsoft Office Suite) and hospital management software (if applicable).Document Management Systems Knowledge of record-keeping and filing systems, both physical and electronic, to ensure compliance with industry standards.Organizational Skills Strong ability to manage multiple tasks, schedules, and priorities in a fast-paced environment.Customer Service Ability to interact effectively with internal staff, external partners, and customers, handling inquiries and aiding as needed.Critical Thinking Ability to quickly assess situations, prioritize needs, and resolve issues efficiently.

Responsibilities

The Referral Center Representative coordinates patient referrals, schedules specialty exams, obtains necessary insurance pre-authorizations, and ensures accurate documentation for timely healthcare access. This role acts as a liaison between patients, providers, and payers while supporting administrative tasks and maintaining HIPAA compliance.