UnityPoint Health Referral Specialist in West Des Moines, Iowa
1.0 FTE 40 hours/week Full Time Benefits
Manage all facets of the patient referral process. The scope of the referral process begins with receipt from the provider through to the communication with the patient. Responsibilities include, but are not limited to, obtaining pre-certification or prior-authorizations, scheduling the visit with specialist or outpatient services, completion of documentation with the electronic medical record (EMR) and communicating referral information to referring offices and to the patient.
Essential functions are the duties and responsibilities that are essential to the position (not a task list). Do not include if less than 5% of work time is spent on this duty. Be specific without giving explicit instructions on how to perform the task. Do not include duties that are to be performed in the future. Duties should be action oriented and avoid vague or general statements.
% of Time
Coordination of Patient Appointments & Authorizations
· Coordinates appointments and relays authorization information to scheduling staff of specialist or outpatient service offices as requested.
· Completes appropriate forms or requisitions needed for referrals or testing, including appropriate CPT/ICD-10 coding.
· Provides appropriate and timely documentation in the patient’s EMR using standardized workflows and processes.
· Builds and maintains positive working relationships with all contacts
· Acts as a liaison between UnityPoint and all referral sources
Correspondence with Patients
· Notifies patient of appointment details via telephone, MyChart, and letter.
· Ensure patients are informed of scheduled tests/procedures.
· Reinforces instructions and explanations of tests/procedures to patients per protocol.
· Utilizes exemplary customer service skills with every patient interaction
Obtain Pre-Certifications and Prior Authorizations
· Obtains insurance pre-certifications and prior authorizations for office procedures, diagnostic testing, and imaging for patients.
· Coordinates pre-certs and authorization processes with scheduling staff so appointments can be made in timely manner.
· Obtains any and all pertinent clinic health information from provider, clinical staff and/or EMR to process authorizations, referrals, and pre-certifications.
· Verifies demographic information, including insurance, when scheduling and/or obtaining pre-certifications.
· Monitors outstanding authorization requests and initiates follow-up of outstanding authorizations in a timely manner.
· Maintains current knowledge of payer specific requirements of prior authorizations by attending virtual workshops, researching, reading newsletters.
Basic UPH Performance Criteria
· Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
· Demonstrates ability to meet business needs of department with regular, reliable attendance.
· Employee maintains current licenses and/or certifications required for the position.
· Practices and reflects knowledge of HIPAA and OSHA and other federal/state regulatory agencies guiding healthcare.
· Completes all annual education and competency requirements within the calendar year.
· Is knowledgeable of clinical and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of Clinic administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.
Identify items that are minimally required to perform the essential functions of this position.
Preferred or Specialized
Not required to perform the essential functions of the position.
· High School diploma or equivalent.
· Graduate of accredited medical assistant, CNA and/or nursing program.
· 2-3 years previous experience in medical field.
· Basic knowledge of medical terminology, anatomy and physiology.
· Experience with insurance verification/pre-authorizations.
· Basic knowledge of Current Procedural Terminology (CPT) and International Classification of Disease (ICD-10) coding
· Valid driver’s license when driving any vehicle for work-related reasons.
· Strong telephone and organizational skills and ability to interact effectively with internal/external customers.
· Writes, reads, comprehends and speaks fluent English.
· Multicultural sensitivity.
· Microsoft Office – basic computer skills.
· Customer/patient focused.
· Critical thinking skills using independent judgment in making decisions.
· Ability to work as a team member.
· Ability to understand and apply guidelines, policies and procedures.
Use of usual and customary equipment used to perform essential functions of the position.
Requisition ID: 2021-89755
Street: 1776 West Lakes Pkwy
Name: 9200 UnityPoint Clinic Affiliate
Name: Referral and Prior Auth Mgmt
FLSA Status: Non-Exempt
Scheduled Hours/Shift: Monday - Friday 8am-5pm
External Company URL: http://www.unitypoint.org