Referral Specialist at Heritage Health - Idaho

Coeur D'Alene, Idaho, United States -

Full Time

Start Date

Immediate

Expiry Date

03 Jun, 26

Salary

28.71

Posted On

05 Mar, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Electronic Health Record (EHR), Prior Authorizations, Medicaid, Medicare, Interpersonal Skills, Medical Procedures, Coding, Data Collection, HIPAA Compliance, OSHA Compliance, Problem Solving, Communication, Organization, Judgment, Decision Making, Conflict Management

Industry

Hospitals and Health Care

Description

Description We are North Idaho’s premier provider of integrated medical, dental and behavioral health services. Our amazing care teams deliver world-class healthcare utilizing a patient directed, community-focused approach. Providing high quality, affordable Healthcare from the Heart is our passion. Our mission is to deliver a healthcare experience that provides hope, inspires change, and extends life for our patients and our community. Top reasons to join our team: Our employees are mission – minded We are passionate about providing excellent patient care Community-focused Committed to a fun and supportive team environment We offer high-quality competitive employee benefits Summary: Works closely with providers, medical assistants, and Triage nurse manager to ensure that a patient’s insurance allows them access to the services requested and to provide quality care to patients in a positive work environment. Requirements Minimum qualifications: High School Diploma or GED. Minimum of one year of prior outpatient healthcare experience preferred. Knowledge, Skills, and Abilities Required: Proficient with computers and telephone. Strong interpersonal skills. Some understanding of medical procedures, specialties and coding preferred. Duties and Responsibilities: Through the Electronic Health Record (EHR), receive requests for referrals. Place the referral into the Orders section of the EHR. Send any relevant records through the EHR to the referral provider. Track the referral in the EHR and ensure that follow up is complete Obtain prior authorizations from insurance companies and Medicaid/Medicare when needed. Manage outgoing vouchers to area providers for our self-pay, Group 1 patients. Answer and route calls from patients regarding referrals. Communicate back to patient care teams when there are difficulties with referrals and patient follow through. Work with supervisor to ensure that processes allow for accurate collection of data for PCMH and Meaningful Use. Maintain positive and collegial environment and professional work ethic. Maintain OSHA and HIPAA compliant work area. Heritage Health staff have an active role in our Patient Centered Medical Home model of care. This role is designated as part of the Heritage Health PCMH Care Team. Regular and predictable attendance is an essential function of this position. Other job-related duties as assigned. Safety: Heritage Health enforces a safety culture whereby all employees have the responsibility for continuously developing and maintaining a safe working environment. Each employee is responsible for completing all training requirements, participating in emergency response tasks as requested, and serving on safety committees and teams as requested. In addition, employees must accept the responsibility for maintaining the safety of themselves and others by adhering to all written and verbal instructions, promptly reporting and/or correcting all hazards or unsafe conditions and providing feedback to supervisors and management on all safety issues. Physical/Mental Requirements: Required to stand, sit, and be mobile one-third to two-thirds of the time. They are required to use hands to finger, handle or feel over two-thirds of the time; while reaching with hands and arms occurs one-third of the day. Climbing or balancing, stooping, kneeling or crouching occur less than one-third of the time. Communicating by talking / hearing occurs over two-thirds of the day. Amount of time spent lifting or exerting force is about 50% for up to 10 pounds and less than one-third of the time up to 25 – 40 pounds. Rarely is there a need to lift more than 41 pounds. Must be able to manage efficient keyboard use, hear, see, speak and read. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to solve complex practical problems Positive interpersonal, communication & persuasion skills over the phone, computer & in person Must be able to simultaneously manage several objectives and assign priorities Deal with a wide variety of variables in situations where only limited standardization exists Ability to interpret a variety of instructions furnished in written or oral form Ability to work effectively under pressure to meet deadlines with a strong organization skill set for easy retrieval of information and to ensure competent closure of issues Ability to work overtime as needed, maintain alertness & meet the controlled substance policy. Good judgment and sound decision making and conflict management skills to inspire confidence from the customer Manage complex analysis and use deductive reasoning Working Conditions: Work is normally performed in a typical interior/office work environment in a clinic. Work may be demanding and chaotic at times. Exposed to patient population that will present a variety of contagious diseases, physical injuries, and emotional states of mind.

Responsibilities

The Referral Specialist receives referral requests via the Electronic Health Record (EHR), places orders, sends relevant records to referral providers, and tracks follow-up completion. This role also involves obtaining prior authorizations from insurance companies and managing outgoing vouchers for self-pay patients.