Referral and Insurance Specialist - Plastic Surgery - Multiple Locations

Referral And Insurance Specialist

Thank you for considering a career at Roper St. Francis Healthcare!

Scheduled Weekly Hours:

40

Work Shift:

Days/Afternoons (United States of America)

Work Shift: Monday - Thursday, 7:30am - 4:30pm and Fridays, 7:30am - 2:00pm

Work Locations: First 6-months, travel to all locations. After training, will work from one location 2-days/week and rotate to other locations 3-days/week for clinic days. All locations are BSSF MOB (West Ashley), Mount Pleasant MOB, and Moncks Corner MOB

Required Experience: 1year+ of medical referral and insurance verifications is required.

Primary Function/General Purpose of Position

The Referral and Insurance Specialist obtains authorizations from insurance companies for referrals to physicians and/or procedures/testing. Verifies eligibility/coverage for referral via phone/fax/Internet. Schedule appointments for testing at medical facilities or appointments with physicians. Gathers charge information and enter all pertinent charge and patient demographic information into computer billing system. Post all payments and make daily deposits. Assist patients regarding billing questions and account balance resolution. Promotes a positive and helpful climate for good interpersonal and interdepartmental relationships.

Essential Job Functions

• Obtains authorizations from insurance companies for referrals to physicians/medical facilities and/or procedures/testing.
• Schedules appointments for testing at medical facilities or appointments with physicians.
• Verifies eligibility/coverage for referral/testing via phone/fax/Internet.
• Investigates billing problems and denials.
• Notifies patients of referral process whether authorized or denied in a timely manner. Give patients instructions.
• Performs data input of patient and/or insurance changes and corrections to ensure current and accurate information in billing system.
• Answers the telephone, take messages, schedule appointments and greet patients as needed.
• Prepares patient charge encounter forms for each day and makes new or updates patient chart as needed.
• Oversees waiting area, coordinate patient movement, and reports problems or irregularities.
• Screens visitors and respond to routine request for information.
• Organizes and files progress notes, testing reports, and other forms necessary for chart completion. Assists with appropriate filing of patient charts as needed.
• Collects patient responsibility balances and copayments as needed. Balance money collected daily.
• Opens and distributes daily mail as needed
• Obtains authorizations from insurance carriers or pharmacy benefit managers for medications.
• Collects all daily charge slips from the physician and reconciles the number of charge slips and their totals
• Applies all payments to the appropriate patient account by posting each into the computer billing systems
• Inputs all charge information into the online billing system
• Assists with coding and error resolution as well as requesting needed information by working with the physician offices
• Works with patients in resolving billing questions and patient account resolution
• As applicable, reviews information to make determination on the appropriate course of action for the patient, makes referrals to the local DSS office as appropriate.

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Licensing/Certification

None

Education

High School Diploma or GED (required)

Work Experience

2-3 years of experience in a related medical field with experience in processing referrals (preferred)

Training

None

Language

None

Patient Population

Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.

Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures.

Neonates (0-4 weeks)

Infant (1-12 months)

Pediatrics (1-12 years)

Adolescents (13-17 years)

Adults (18-64 years)

Geriatrics (65 years and older)

Not applicable to this position

Working Conditions

Periods of high stress and fluctuating workloads may occur.

Long-distance or air travel as needed- not to exceed 10% travel.

General office environment.

May be exposed to high noise levels and bright lights.

May be exposed to physical altercations and verbal abuse.

May be exposed to limited hazardous substances or body fluids.*

May be required to use physical restraints.

May be exposed to human blood and other potentially infectious materials.*

May be exposed to adverse weather conditions; cold, hot, dust, wind, etc.

May have periods of constant interruptions.

Required to car travel to off-site locations, occasionally in adverse weather conditions.

Prolonged periods of working alone.

* Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.

Physical Requirements

Physical Demands

Frequency 0% 1-33% 34-66% 67-100%

Lifting/ Carrying (0-50 lbs.) X

Lifting/ Carrying (50-100 lbs.) X

Push/ Pull (0-50 lbs.)

Push/ Pull (50-100 lbs.)

Stoop, Kneel X

Crawling X

Climbing X

Balance X

Bending X

Work Position

Frequency 0% 1-33% 34-66% 67-100%

Sitting X

Walking X

Standing X

Additional Physical Requirements/Hazards

Physical Requirements

Manual dexterity (eye/hand coordination)

Perform shift work

Maneuver weight of patients

x Hear alarms/telephone/audio recordings

Reach above shoulder

x Repetitive arm/hand movements

x Finger Dexterity

Color Vision

Acuity far

Acuity near

Not applicable to this position

Hazards

Depth perception

Use of Latex products

Exposure to toxic/caustic/chemicals/detergents

Exposure to moving mechanical parts

Exposure to dust/fumes

Exposure to potential electrical shock

Exposure to x ray/electromagnetic energy

Exposure to high pitched noises

Gaseous risk exposure

Other:

Not applicable to this position

Skills

Attention to detailOrganizedAbility to multi-taskExcellent customer serviceActive ListeningVerbal CommunicationWritten Communication

Process RequestsTelephone etiquetteComputer proficiency

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