PUBLIC NOTICE POSITION SUMMARY

PUBLIC NOTICE

POSITION SUMMARY

Under the direction of the Rural health clinic manager, the Referral and authorization Specialist coordinates and completes incoming and outgoing referrals in the Rural Health Clinic. Ensures services referred/ordered have all supporting documentation required by insurance payers and pass medical necessity guidelines. Works with MA’s and Nursing staff of referring providers to obtain additional information when necessary. Facilitates patient medical and financial clearance, obtains authorization of services when applicable. Works directly with patients to ensure scheduling of referred services.

POSITION QUALIFICATIONS OPTIONS

The ideal candidate will possess the following qualifications to be considered.

Education High school diploma or General Equivalency Diploma (GED).

Preferred: Associate/Bachelor’s degree in Healthcare/Medical Coding/Billing/Business or other related field of study.

Experience: One-year healthcare experience or an equivalent combination of education and/or related experience.

Job Type: Full Time/Non-Exempt

Required Skills, knowledge, and abilities:

• Excellent verbal and written communication skills.

• Ability to examine medical records and verify patient identification.

• Knowledge of Common Procedural Codes (CPT), Healthcare Common Procedure Codes (HCPC), and medical billing claim forms preferred.

• Knowledge of standard medical terminology, basic human anatomy and medical record format, contact and medical documentation order preferred.

• Detail orientated and ability to be self-motivated to prioritize and make decisions to complete duties in a timely manner with limited supervision.

• Ability to work under pressure of deadlines.

• Excellent interpersonal communication and team skills in a complete organizational setting.

• Excellent internal and external customer services skills with the ability to remain calm, be patient and respond professionally to all requests.

• Proficient in the operation and use of computers and scanners including various software programs, word programs, and spreadsheets.

• Ability to maintain patient and employee confidentiality.

• Ability to perform repetitious movement, including long periods of standing or sitting, along with the ability to stoop, bend, reach, step up.

• Ability to type at least 45 wpm.

ESSENTIAL FUNCTIONS

• Coordinates and schedules patient care for all incoming clinic referrals received. Facilitates communication between patient and departments.

• Responds to telephone inquiries regarding scheduling and referrals. Communicates with clinic manager, ordering providers and clinic staff regarding insurance authorizations, denials, peer-to-peer review requests and scheduling difficulties.

• Processes all requests for needed authorizations. Prepares, and sends via FAX outgoing referral requests. Informs patients of appointment information and instructions.

• Maintains electronic health record (EHR) referral documentation to reflect actions on specific referrals (including adding incoming referrals that were not generated from the electronic health record (EHR).

• Schedules referral appointments with appropriate department or referred to provider. Tracks referral patient’s compliance and communicates with Clinic Manger and referring provider as necessary regarding patients refusing service and patients not showing up to a referral appointment.

• Collaborates with patient financial services to ensure appropriate authorizations are obtained when applicable. Submits documentation for required authorizations, any retro-authorizations as appropriate, files and appeals for any denials of services if necessary.

• Collaborate with Clinic Manager to support the development and enhancement of internal processes and procedures that lead to delay in claims payments.

• Other duties as assigned.

Scheduling and Referral Specialist- $17.01-$22.19

Applicants are also welcome to apply to http://www.earh.org

Published: June 26 and July 3, 2024