To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
Under the direction of the NEMG Operations Team, serves to coordinate the transfer of care for patients across the healthcare system. The Referral Associate works with the patient along with the clinical team to coordinate any referrals/authorization process to ensure all patient needs are being addressed efficiently and completely across the continuum of care. Primary duty is to obtain prior authorization of scheduled procedures to provide effective Customer Service while insuring optimal reimbursement. Some traveling to the NEMG sites may be required.
1. Answer calls from physicians offices and patients using exemplary customer service skills.
2. Contact insurance companies to ensure prior authorization requirements are met. Present necessary medical information such as history, diagnosis and reason for test/referral. Provide specific medical information to the insurance company to avoid denials.
3. Accurately enter required work queue information (non-clinical and structured clinical data) into EPIC, ensure work queues are monitored daily and authorizations are obtained in a timely manner.
4. Review structured clinical data matching it against specified medical terms and diagnoses or procedure codes (without the need for interpretation) and follow established procedures for authorizing request or referring request for further review to meet medical necessity.
5. If necessary, scan incoming information into EPIC and follow established procedures for distributing information for further review.
6. Be the system navigator and point of contact for patients, families & physician's offices, with patient and physicians having direct access for asking questions and raising concerns. May assume the patient advocate role on the patients' behalf with carrier to ensure approval of the necessary services for the patient in a timely fashion.
7. Call back providers with pre-authorization numbers per established guidelines. Help to coordinate any peer to peer reviews required by the insurance company.
8. Print and send form letters as needed
9. Performs other related duties, assignments and responsibilities as assigned or required.
10. Review and update any demographic and insurance information in EPIC to ensure complete and accurate referral/authorization process
11. Maintain current knowledge of insurance guidelines related to referrals and authorizations. Encouraged to attend insurance informational sessions and other training sessions to keep current on policies.
12. Schedule the appointments and tests on behalf of the patient.
13. Monitor and work the tracking work queue for primary care to ensure the patient receives their test, the external specialist was seen, and insuring the note is in EPIC
High School degree or equivalent required
Minimum three years experience working in a medical or insurance office. Experience with pre authorizations or insurance verifications preferred.
Understanding of Medical Terminology. ICD10 coding knowledge beneficial. Excellent demonstrated communication skills, computer literate, working knowledge of EPIC electronic medical record is preferred. Insurance referral processing experience preferred. In accordance with the NEMG Service Excellence standards of operation, provide service excellence to patients, physicians and fellow NEMG Employees.
Light lifting and bending. Majority of the job is sedentary.
Good vision and hearing with or without assistive devices is a requirement.