This position is responsible for coordinating referral orders for a continuation of treatment, such as specialty services and diagnostic testing within a multispecialty practice. This position provides all pertinent clinical information needed for the payor authorization and the facility or specialist prior to the services being rendered. The position acts as a liaison between the patient and the specialty area by navigating the appointment process, and ensuring that proper authorization(s) are obtained for the appointment, to provide a seamless experience for our patients. This position is responsible for tracking and managing all referrals with the intention and outcome to close any patient care gaps, along with providing documentation to promote team awareness.
Schedules and/or coordinates the scheduling of appointments for incoming referrals to assigned specialty physician services and/or diagnostic testing per provider request and communicates with the patient on a timely basis for all scheduling requirements.
Schedules and/or coordinates the scheduling and authorizations for provider pre-planned in office procedures ordered by assigned specialty(ies).
Acts as a liaison between patients, providers, departments and staff members for patients referral and follow up needs. Provides prompt and professional service for the patients by assisting in educating patient/family and assisting patients with external resources when needed.
Collaborates with providers and departments of assigned specialty(ies) to determine all CPT Codes provider will need authorized before appointment.
Provides all pertinent clinical information needed for the payor authorization, the facility or specialist prior to the services being rendered by verifying coverage, obtaining authorization and communicating with receiving facilities for incoming referrals as well as pre-planned in office procedures.
Reviews upcoming provider schedules to ensure all appointments have appropriate referral and authorizations required for anticipated visits and procedures.
Applies knowledge of medical terminology, ICD-10 and CPT Codes and maintains up to date knowledge of insurance environment. Utilizes internal and external resources to seek knowledge about regulations regarding various payor sources.
Collaborates with outside referral sources and other community resources. Maintains an updated list of community resources and networks with colleagues to develop additional referral sources.
High school diploma/GED or equivalent working knowledge.
Requires knowledge of medical terminology, ICD-10, CPT Codes and a broad understanding of all common insurance and payor types and authorization requirements, normally acquired over a two or more years of work experience in the healthcare field. Strong knowledge in the use of common office software, word processing, spreadsheet, EMR software are required. Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently. Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences. Knowledge of HIPAA regulations. Strong customer service focus and willingness to problem solve.
Previous knowledge of managed care concepts. Working knowledge of medical terminology and ICD-10and CPT codes.
Additional related education and/or experience preferred.
Internal Number: 262999
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.