Job Description

Overview

You know that your job is about much more than gathering referral and payer information. As a Revenue and Referral Intake Specialist, you are the important link between patients and physician referrals. You are the calm presence that provides all parties with the information they need for the best possible experience. You treat all parties with the dignity that is a hallmark of the Legacy community. If this describes you, wed like you to consider this opportunity.

The Revenue and Referral Intake Specialist (RRIS) provides support to patients, providers, and staff for a wide variety of complex tasks such as initial patient registration, scheduling evaluation(s), referral, insurance authorization, charge and coding review.

Responsibilities

• REFERRALS/ PRIOR AUTHORIZATION: Processing of all referrals and prior authorizations (hereafter referred to as referral) to ensure timely handling in order to meet the departments financial, customer service and regulatory standards.
• Provides education and customer service to providers, staff and patients regarding the department referral process.
• Provides data entry and clerical support for the referral process for both pre-paid and fee-for-service health plans.
• Understands each health plans guidelines, benefits and basic risk models.
• Understands and follows departments referral processes and procedures.
• Performs insurance verification and authorization including eligibility checks and complex phone calls to insurance companies to determine patient coverage.
• Performs ongoing insurance reauthorization as needed.
• Identifies and resolves patient, provider, department and insurance company concerns, requests and problems related to referral issues.

• CHARGE CAPTURE: Monitors charge capture process to ensure timely handling in order to meet the departments financial, customer service, and regulatory standards.
• Provides assistance and direction to providers and staff on missing, incomplete or inaccurate charges.
• Assists providers and staff in assigning appropriate Diagnosis and CPT codes and researching problems and/or concerns as needed.
• Reviews charges and documentation to ensure appropriate use of CPT/Diagnosis coding practices. Acts as a liaison between providers and revenue cycle departments.
• Verifies that billable visits have charges attached.
• Works assigned Charge Review Work Queues and inpatient reconciliation report in a timely manner.
• Acts as liaison between department staff, providers and billing department.

• ACCOUNT AND PATIENT ISSUES: Handles person-to-person patient inquiries regarding referral issues. Follows up with patient and other key players until issues are resolved.
• Identifies and resolves patient, physician, department and insurance company concerns, requests and problems related to referral issues.
• Problem solves issues in a professional manner.
• Works cooperatively with other staff to resolve issues for patients and providers.

• SCHEDULE EVALUATION(S) AND REGISTRATION: The RRIS schedules evaluation appointment(s) for a patient following the guidelines of the scheduling protocol for the respective Legacy Program.

• PROFESSIONAL BEHAVIOR: Maintains the respect and confidence of others, including physicians, customers, patients and coworkers, by exhibiting professional appearance, proper conduct, punctual attendance, dependability and a positive attitude.
• Meets established guest relations standards of professional behavior and confidentiality.
• Greets and directs patients, visitors and other employees as per department procedures.
• Provides customer service by phone or in person in a prompt, courteous and complete manner.
• Responds to requests for information courteously and efficiently.
• Takes complete, accurate and timely telephone and verbal messages in a professional manner.
• Presents professional image to customers and staff in a pleasant and helpful manner.
• Takes on special responsibilities and projects in areas as requested.
• Acts as liaison to communicate departmental information to customers regarding department operations.

• OTHER: Additional functions may include but is not limited to: Independently initiates required reports.
• Communicates swiftly with Supervisor or Manager at the site if work load issues are resulting in a delay of charge review workqueue(s), authorizations, timely processing of referrals and or scheduling
• May assist with cash handling.
• May float to other departments as needed to maintain core staffing at managers discretion to cover similar roles and or responsibilities (e.g., registration or scheduling).

Qualifications

• Education: Associates degree in business or healthcare, or equivalent experience, required.
• Experience: Standard office computer and keyboarding experience required.
• Skills: Excellent verbal and written communication skills.
• Attention to detail, accuracy and organizational skills.
• Knowledge of medical terminology.
• Keyboard skills and ability to navigate electronic systems applicable to job functions.
• Knowledge of CPT and ICD-10 coding preferred.
• Knowledge of insurance and managed care practices preferred.

Equal employment opportunity, including veterans and individuals with disabilities.

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