Patient Access Referral Specialist - Hospital - Tulsa

Patient Access Referral Specialist

The Patient Access Referral Specialist is responsible for receiving, reviewing, and processing non-established incoming referrals, orders, and requests for services. This position serves as a liaison between patients, providers, clinical staff, and outside facilities to ensure all required information is obtained, and services are coordinated efficiently and accurately.

Work is performed in a hospital and ambulatory health care setting. Risk of exposure to infectious disease does exist.

Performance of duties requires being seated for long periods entering data and requires the demands of normal office work.

Satisfactory job performance will be determined by successful execution of the following:

1. Responsible for receiving and processing non-established incoming referrals and service requests. Verify patient demographics, insurance coverage and eligibility. Obtain and review required clinical documentation.
2. Assigning accurate MRNs, completing medical necessity / compliance checks, providing proper patient instructions, collecting insurance information, obtaining necessary authorizations, receiving and processing physician orders, while providing excellent customer service. Schedule and confirm patient appointments. Coordinate with medical staff to ensure timely and efficient scheduling. Manage appointment cancellations and rescheduling as needed. Operates the telephone to relay incoming calls as applicable. They are to adhere to policies and provide excellent customer service in these interactions with appropriate level of compassion.
3. Specialists are responsible for the pre-registration, authorization, and patient accounts prior to patient visits. They may include incoming and internal, calling to obtain demographic, insurance, and other patient information, including the patient financial liability, authorization and collecting point of service collections.
4. Specialist explains general consent for treatment forms to the patient/guardian/guarantor/legal guardian, obtain necessary signatures and witness's name. Explains and distributes patient education documents, such as Important Message for Medicare, MOON form, Consent forms, and all forms implemented for future services.
5. Reviews eligibility responses in the insurance verification system (EPIC), and appropriately selects the applicable insurance plan code, enters benefit data into system to support point of service collections and billing processes to assist with a clean claim rate.
6. Responsible for accurate screening of medical necessity using Advanced Beneficiary Notice (ABN) software to inform Medicare patients if possible, non-payment of test by Medicare and distribution of the ABN as appropriate. Responsible for distribution and documentation of other design designated forms and pamphlets.
7. Effectively manage time and prioritize tasks to maximize productivity.
8. Provide support to colleagues to foster a positive work environment.
9. Consistently adheres to all department policies and procedures.
10. Collaborate seamlessly with other revenue cycle teams to address and resolve issues while delivering a high-level, personalized service within the defined team scope.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Muscogee (Creek) Nation Department of Health