Referral Specialist: Orthopedic Care-Bettendorf

Overview

Employment Type: Full time Shift: Day Shift Description: The Referral Specialist manages and facilitates patient referrals, authorizations, and scheduling appointments, tests, and procedures at designated locations. Serving as a liaison between patients, providers, and medical support staff, the referral specialist ensures timely coordination of care by verifying insurance eligibility, obtaining prior authorizations, and entering necessary demographic and insurance information into clinic and hospital systems.

The role also includes handling phone communications, supporting referral management operations, and adhering to the mission, vision, and performance expectations of Mercy One Medical Group.

At Mercy One, health care is more than just a doctor’s visit or a place to go when you’re in need of medical attention. Our Mission is based on improving the health of our communities – that means not only when you are sick but keeping you well.

Mercy One Genesis serves a 17-county bi-state region of the Quad Cities (Davenport and Bettendorf, Iowa, and Rock Island and Moline, Ill.) metropolitan area and the surrounding communities of Eastern Iowa and Western Illinois. But when it comes to clinical capabilities and quality, we exceed those geographical limits. We have earned distinction as a two-time national Top 15 Health System, and recognition for being in the top 1 percent in the nation for patient safety.

Position Title: Referral Specialist

Department: Orthopedic Care, Bettendorf Health Plex

• Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

• Works directly with patients, families, insurance representatives, physicians, and vendors to facilitate the referral process.

• Coordinates, processes, and tracks patient referrals, authorizations, and scheduling with accuracy and attention to detail.

• Verifies insurance coverage, obtains prior authorizations, and communicates approval/denial to patients.

• Schedules patient appointments with appropriate specialists and providers, ensuring timely communication of appointment details.

• Maintains accurate documentation of referrals, prior authorizations, communications, and patient scheduling in the EMR system.

• Assists patients with insurance verification, prior authorizations, and required documentation for medical services and tests.

• Communicates and follows up with insurance companies, providers, and patients regarding referral status, appointments, and test results.

• Supports network integrity and aligns work to organizational goals. Collaborates with colleagues across the continuum of care to ensure consistent patient care and the timely processing of referrals and test results.

• Ensures patient confidentiality and compliance with HIPAA regulations in all interactions and documentation.

• Maintains knowledge of relevant laws, regulations, and organizational policies to ensure ethical and professional behavior.

• Supports department efficiency by contributing to the improvement of workflow processes related to referral and authorization tasks.

• Proactively serves as a patient advocate by utilizing courteous and professional etiquette at all times reflecting positive tone and speaking distinctly with poise, tact and assurance. Assures accurate and complete messages to appropriate personnel.

• Work includes cross coverage in other clinic areas as team needs.

• Assists in training, orienting, and supporting new colleagues.

• Other duties as needed and assigned by the manager.

• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

MINIMUM QUALIFICATIONS

• Must be comfortable operating in a collaborative, shared leadership environment.

• High school diploma or equivalent required.

• Minimum of 1 year of relevant experience in a healthcare setting required, with prior medical office experience preferred.

• Knowledge of ICD, CPT coding, medical…