Appeal Resolution Specialist jobs in Kennewick, WA

CHI St. Anthony Hospital is a 25 bed licensed for 49 faith-based acute care level four trauma critical access hospital and healthcare campus serving the Pendleton Oregon area for more than 100 years. We are committed to the highest quality of patient care and safety; and to strengthening our community through wellness education. CHI St. Anthony Hospital is designed specifically to ensure that our physicians nurses and healthcare professionals can continue to provide extraordinary care for our patients. The 103000 square foot hospital features 4 operations rooms 11 emergency rooms 30 private patient rooms and the latest medical equipment. St. Anthony Hospital has plenty of room to grow as needed by the community and will continue to provide the safest quality of care possible. St. Anthony Hospital was also named one of the top patient experience hospitals in 2021. CHI St. Anthony is a member of CommonSpirit Health the largest not-for-profit health care system in the nation boasting an integrated network of top quality hospitals with physicians from the most prestigious medical schools and comprehensive outpatient services-all recognized for quality safety and service. To learn more go to www.sahpendleton.org

While you’re busy impacting the healthcare industry, we’ll take care of you with  benefits that may include health/dental/vision, FSA, matching retirement plans,  paid time off, tuition assistance, adoption assistance, and more!

Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified

Job Summary:

The Referral Specialist works with patients requiring a referral, to ensure patient’s referral needs are fulfilled for specialty service office visits.  Processes referrals, authorizations and pre-certifications for patients, to ensure timely reimbursement. 

Essential Functions:

• Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.
• Communicate detailed information and answers patients' questions regarding their health care plan; provide answers to billing and insurance clarification questions.
• Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc.
• Coordinate flow of information between medical clinic and referral authorization department to secure a valid referral for clinic patient.
• Enter referrals, documents communications and action into the system, as appropriate. 
• Notify physician(s) and patient when referral is denied, or if additional information is needed.
• Develop and maintain database of referral physician offices preferred by each physician within the clinic.
• Assist Practice Manager with complaint resolution and solutions related to patient referrals.
• Perform other duties as assigned by the practice manager or physician.

Required Education and Experience:

• High school diploma or GED
• Two (2) years of progressively responsible related experience in a healthcare environment

Required Minimum Knowledge, Skills and Abilities:

• Language Ability:  Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to common inquiries or complaints from groups of managers, clients, customers, and the general public.

• Math Ability: Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

• Reasoning Ability:  Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

• Computer Skills:  Must be proficient with the Microsoft Office Suite, Internet navigation, database management, desktop publishing, spreadsheet, and graphic presentation packages.