Referral Specialist - Pharmacist Provider Service (Per Diem)

Job Title

Responsible for the coordination and administrative requirements for patient referral from primary care providers (PCP) and specialists to pharmacist specialty services, dealing directly with health plans. Responsible for processing pre-authorizations related to medications and services from the department. Makes decisions and authorizes risk planning referrals, utilizing department and organizational guidelines. Requires daily interaction with patients, staff, healthcare providers and insurance companies.

Primary Duties:

1. Demonstrates mastery of all Patient Service Representative duties.
2. Processes patient referrals from PCP to specialist, working directly with health plans, troubleshooting when necessary.
3. Serves as a point person coordinating information regarding managed care referrals for patients, providers, and other Utilization Management staff.
4. Assigns proper ICD-10 and CPT code(s) to patient referrals.
5. Responsible for communication and dissemination of key managed care contractual information and system processes to patients and staff.
6. Identifies and communicates changes in insurance requirements, provider changes and guidelines to leaders and team members.
7. Processes medical and pharmacy pre-authorizations for medications and services ordered by the department clinical staff.
8. Performs other duties as assigned.

License, Certification, Education or Experience:

REQUIRED for the position:

• Associate degree or equivalent combination of education and experience
• 2 years of experience in a healthcare insurance or related medical office setting
• Working knowledge of ICD-10 and CPT codes
• Ability to be flexible and relate well with others in a professional and pleasant manner
• Knowledge of medical records confidentiality
• Excellent communication skills with a high degree of tact and poise to deal effectively with patients, physicians, and hospital staff members

DESIRED for the position:

• Medical Terminology, medical billing, and computer skills
• Working knowledge of insurances, Medicare, DSHS, Labor and Industries, and other third-party insurances

Benefit Information: Choices that care for you and your family

At EvergreenHealth, we appreciate our employees' commitment and contribution to our success. We are proud to offer the following benefits and resources for our per diem staff to help maintain and improve health and financial well-being.

• Washington Paid Sick Leave (WPSL)
• Participation in 457(b) retirement plan
• Free parking
• Cafeteria & Gift Shop Discount