Referral Rep - Primary Care

Description:

JOB PURPOSE:
Processes all referral requests for the practice, including in-office and telephone requests for primary care physician to specialist physician referrals, in accordance with individual office protocol while following mandated insurance guidelines.

MINIMUM EDUCATION REQUIRED:
High school diploma or general education degree (GED)
MINIMUM EXPERIENCE REQUIRED:
Two (2) years of related experience, preferably a medical office setting. Associates degree can substituted in lieu of experience requirement.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
None.
ADDITIONAL QUALIFICATIONS:
None.
KEY RESPONSIBILITIES:
Obtains all information indicated for processing referrals in a timely fashion. When missing necessary information, communicates this to the patient.
Processes all routine, non-emergency referrals within 72 hours.
Performs insurance verification procedures as needed per office protocol.
Assists clinical staff and physicians in coordinating precertifications for procedures, if indicated as integral part of office referral.
Communicates with insurance companies, required to attend mandatory scheduled meetings relating to managed care issues and any meetings or in-services conducted by participating insurance companies.
Maintains latest issues of participating physician manuals, requests updates routinely.
Processes same-day referrals in accordance with emergencies as they occur; communicates with office personnel of specialist physician to expedite patient care.
Ensures that the office remains compliant with insurance utilization mandates. This may indicate performing telephone triage, under physicians guidance, of patient requesting referral to specialist. May schedule patients to visit the office for determination of need of referral, as indicated.
Maintains record keeping system of processed referrals.
KNOWLEDGE, SKILLS, ABILITIES
Skill and ability to communicate effectively both verbally and in-writing.
Skill and ability to handle multiple priorities and deadlines.
Ability to work as a member of a team.
Skill and ability in Microsoft Office applications.
Disclaimer
The above information is intended to describe the general nature and level of work being performed by people assigned to this job. It is not intended to be an exhaustive list of responsibilities, duties and skills required of personnel so classified.