Description
Referral Coordinator Full Time Days AdventHealth Manchester Location Address: 210 Marie Langdon Drive, Manchester, KY 40962 Top Reasons To Work At AdventHealth Manchester: Small town with a family-like workplace Centrally located to outdoor recreation activities Faith based Organization Community Involvement always giving back to the community Career Advancement Work Hours/Shift: Full Time Days What You Will Be Responsible For: · Possesses a strong knowledge, understanding, and competency in the areas of insurance carrier plans and coverage benefits, Local Coverage Determinations, Radiology procedures, CPT codes, HCPCS, and ICD-10 codes. · Ensures pre-certification and verification of benefits has been obtained and clearly documented on all required exams 10 business days prior to patientâ™s procedure, or within 24 hours of scheduling, or same day add-ons determined at the time of scheduling. · Works a minimum of 3 days out on verification of benefits. · Determines if patientâ™s insurance is a part of the provider network · Possesses a strong knowledge of required waivers or documents necessity (Ex: Medicare ABNâ™s, auto forms, clinical documents, EMRs, and orders). · Makes outgoing calls or utilizes on-line recourses to obtain for pre-certification or any authorization required by the insurance carriers. · Contacts patient or physicianâ™s office using HIPAA guidelines prior to scheduled exam when additional information is required. · Serves as an insurance expert in assisting customer service representatives, front desk associates, account representatives, center directors, and technologists in answering insurance related questions. · Notifies patients, referring physicians, VIP specialists, site manager, and support staff with regard to appointment cancellations as a result of insurance denial, delay in obtaining insurance authorization while effectively explaining the reason for the denial or delay. · Works as a liaison for site managers, hospital managers helping potentially fill next dayâ™s schedule for CT/MR exams. · Patient Refuse Referrals, Do not delete refused referrals. Document patient refusal, cancel-close referral. · Weekly review of Open Status Referrals with Patient Resource Supervisor. · Performs other duties as assigned, to ensure the smooth operation of the department.
Qualifications
What You Will Need: · Ability to work in a team setting, as well as, independently · Must have a working knowledge of Microsoft Office products · Strong Customer Service Background · Ability to type 50 wpm · Ability to work in a team setting, as well as, independently · Able to make decisions and solve problems in assigned work area · Ability to work well under pressure with deadlines - sense of urgency · Ability to prioritize and manage simultaneous assignments with frequent interruptions while paying close attention to the details · Understanding of Local Coverage Determinations · Medical terminology and office background preferred · Understanding of Coinsurance, Co-payâ™s and deductibles and the ability to explain, preferred · High school diploma or equivalent required · Bachelorâ™s degree preferred
Job Summary: Direct reporting to the Patient Resource Supervisor. Is accountable for providing quality customer service & patient financial responsibilities to patients, referring physicians, visitors and internal customers by obtaining insurance pre-certification and benefit verification for imaging procedures. Develops and maintains positive relationships with physicianâ™s offices, patients, and sites while conveying accurate benefit and payment details in regard to any and all future visits. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. | 
