Referral Specialist: Orthopedic Care-Bettendorf

Overview

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.

Employment Type Full time

Shift Day Shift

• 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.

• 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 terminology, and healthcare billing/authorization processes is preferred.
• Ability to maintain confidentiality and adhere to HIPAA regulations.
• Must be able to communicate effectively, both verbally and in writing, and demonstrate proper telephone etiquette.
• Strong interpersonal skills with the ability to interact professionally with patients, healthcare providers, and the public. Must maintain a high degree of confidentiality when dealing with patient information.
• Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
• Must possess the ability to interact. Interaction is with a variety of people inside or outside the organization. Communications are…