Referral Specialist processes insurance pre-verification for hospital admissions or specialty service office visits. Gathers pertinent information from patients, insurance carriers, financial counselors, and other staff to confirm the patient's financial obligations for services. Being a Referral Specialist acts as a liaison between hospitals, clinical staff, health plans, providers, and patients to process referrals. Verifies insurance coverage and obtains required authorizations when necessary. Additionally, Referral Specialist documents referrals, communications, actions, and other data in an information management system. Generates and distributes all applicable forms, notifications, and paperwork. Requires a high school diploma. Typically reports to a supervisor. The Referral Specialist works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Referral Specialist typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
Penn State Health Community Medical Group
Location : US:PA: Lititz
Work Type : Full Time
FTE : 1.00
Shift : Day
Hours : Monday-Friday; 8:00a - 4:30p
JOB SUMMARY:
Responsible for providing patient registration, CPT/ICD 9 codes and insurance verification. Registration responsibilities include completing the appropriate registration for the services the patient will be receiving, maintaining encounter integrity by selecting the appropriate billing number to produce the visit, verifying patient demographic and insurance information and working closely with the provider/clinic staff to collect specific clinical information required for obtaining authorizations. Insurance Verification includes confirming eligibility and obtaining benefit specifics, documentation of specifics, and obtaining referrals from internal and external customers for authorization to optimize reimbursement and prevent denials.
MINIMUM QUALIFICATION(S):
High School Diploma or equivalent
WHY PENN STATE HEALTH?
Penn State Health offers exceptional opportunities to learn and grow, exposure to a wide patient population and the ability to provide individualized, innovative, and specialized care to patients in the community.
This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.
Penn State Health is fundamentally committed to the diversity of our faculty and staff. We believe diversity is unapologetically expressing itself through every person's perspectives and lived experiences. We are an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information. If you are unable to use our online application process due to an impairment or disability, please call 717-531-8440 between the hours of 7:30 AM and 4:30 PM, Eastern Standard Time, Monday through Friday, email hrsolutions@pennstatehealth.psu.edu or download our Accommodation Instructions for Job Applicants PDF for more detailed steps for assistance.
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