Centralized Referral Rep-Centralized Referral Ctr

Job Requirements

For this position, we are seeking a candidate that has referral experience and prior authorization experience.

This position receives, coordinates and implements the initial patient experience by providing critical functions essential to ensuring proper billing and reimbursement, patient satisfaction as well as efficient and accurate handling of the referral process. This position is responsible for all pre service functions; which includes receiving the referral request via EMR system and non-EMR systems, appointment scheduling, insurance prior authorization and notification, validating medical orders, procedure protocol clearance, patient pre-registration by telephone, insurance eligibility, verification of benefits and financial clearance (patient responsibility collections prior to service) of scheduled outpatient and all inpatient accounts for SMC and PMC. This includes but is not limited to government, commercial, managed care, grant & philanthropic funds and patient responsibility accounts.

Minimum Requirements

Education

• High School Diploma or GED

Experience

• 1-3 years in a healthcare, finance or customer service setting

License/Registration/Certifications

• N/A

Preferred Requirements

Preferred Education

• Associate’s or bachelor’s degree

Preferred Experience

• 4-7 years in a healthcare, finance or customer service setting

Preferred License/Registration/Certifications

• CHAA or CMIS

Core Job Responsibilities

• The CRC Representative is responsible for the daily completion of authorizations of procedures, obtaining clinical data for procedure clearance per imaging protocols, insurance eligibility, price estimates, collections, contact patients for pre-registration demographic and financial information and imaging scheduling
• This position serves the critical role of maintaining an effective and comprehensive relationship with external and internal physician customers
• The CRC Representative serves as the contact person for insurance case managers
• Must be able to effectively work with Case Management, Medical Group of the Carolinas, Business Services, and Patient Access Services
• Excellent day to day working relationship with services lines for Imaging modalities & locations, Surgery, Anesthesia, Language, Food & Nutrition, Laboratory and all Cardiac Services
• Reports directly to the Manager of the Centralized Referral Center and maintains a close and effective working relationship with other associates and leadership roles to ensure efficient collaboration of pre-service and patient flow operations
• This position is responsible for production and adherence to measurable strategic departmental and system goals in relation to the expected process of patient flow, prevention of denials and point of service cash collection performance measures.
• Must demonstrate discretion in handling confidential information and work professionally with

patients, families, physicians and other departments