REFERRAL SPECIALIST- FAMILY MEDICINE

JOB RESPONSIBILITIES:

Verifies insurance coverage to initiate and /or perform the referral process.   Completes prior authorization processes and functions as a liaison between hospitals, physicians, patients and health plans.

Authorize insurance information and verify patient eligibility to prevent accidentally   scheduling services for treatment with clinical specialist who are not approved by their insurance provider. Acts as a resource to patients, physicians and nursing staff for questions and prior authorizations.   

Educates physicians and staff members regarding various insurance changes pertaining to referrals and authorizations.                  

Stays up to date regarding contractual obligations to specific insurance companies.

Communicates effectively with patients regarding approval and denials regarding authorizations. Maintains effective and positive communication with physicians, members of the department and organization.

Knowledge base and continual understanding of medical terminology, ICD 10 codes, and primary diagnosis.

Clearly communicates and continuously supports the Mission and Values of JMH. While fostering positive working relationships and displays leadership skills in working with physicians, staff, outside medical facilities, hospitals, and outpatient services.

Scans documents into JMH electronic medical record system ensuring patient information and authorization(s) for service(s) are completed and accurate in the patient medical record.

Performs PSR (patient service rep) duties and responsibilities when covering PSR   position at the check-in/out desk, which may include one or more of the following:

• Greet patients and all visitors
• Verify and input accurate patient demographic and insurance information
• Completes the registration process, which includes obtaining photo ID and signature(s) on patient intake forms.
• Prepares charts for appointments, assuring that pertinent medical information and updated demographics/insurance information is placed in the patient’s chart.

Answers multi-line phone calls, directs calls appropriately, and schedules appointments when needed.

Performs additional duties not addressed here as assigned by the Senior Practice Manager and/or the JMH Vice President of Physician Practices.                     

Clearly communicates and continuously supports the Mission and Values of Johnson Memorial Health (JMH).

Conducts all activities in compliance with applicable laws, regulations, standards, and JMH policies and procedures including Blood and Body Substance Precautions.

EDUCATION, EXPERIENCE AND TRAINING: 

High School Diploma or equivalent required. Prefer 1-2 years of work experience in a medical or physician office setting. General knowledge of information systems and EMR technology experience preferred.

Johnson Memorial Health is a nationally-recognized network of physicians, services and healthcare resources based in Johnson County, Indiana. The centerpiece is Johnson Memorial Hospital, located in Franklin Indiana, just 20 minutes south of Indianapolis.

All qualified applicants will receive consideration for employment without regard to race, age, sex, color, religion, sexual orientation, gender identity, national origin, protected veteran status, disability, or other protected characteristic under applicable law.

SCHEDULE: