Essential Key Job Responsibilities

• Knowledge of federal and state pay requirements, including Medicare, DSHS, HMO/PPO Contracts.
• Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc.
• Gather, verify, and process orders for test, referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.
• Notify physician(s) and patient when test or referral is denied, or if additional information is needed.
• Maintains supply of contrasting prep for testing so that when patients are scheduled the prep can be given to the patient and the patient can be educated as to the prep. Otherwise patients are told to be at the testing site 1 ½ hours early for prep.
• Communicate detailed information and answers patients' questions regarding their health care plan; provide answers to billing and insurance clarification questions.
• Develop and maintain database of referral physician offices preferred by each physician within the clinic.
• Coordinate flow of information between medical clinic and patients insurance for referral authorization to secure a valid referral for clinic patient.
• Knowledge of clinic referral and scheduling processes and billing/authorization requirements.
• Communicates or gives written material to patients with referral information such as date, time, and location, as well as contact information to ensure patient has resources to review if needed.
• Enter and annotate testing information and referrals, does e-referral for applicable practices for meaningful use and follows-up to make sure e-referral and or faxed referrals are received, documents communications and action into PPMS and AEHR, as appropriate.
• Maintains complaint resolution and solutions related to patient referrals. Calls or faxes for test and referral documents, documents in notes when attempts are made to reconcile the test or referral. Scans the documents into the system and closes the order or referral. Documents all test and referrals in PPMS and AEHR for outmigration reporting.

• High school diploma or equivalent required.

• Experience in AEHR and PPMS systems is preferred.
• 2 years of progressively responsible related experience in a healthcare office environment specializing in the referral process is preferred.