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Inspire health. Serve with compassion. Be the difference. Job Summary Provides patients a seamless entry into the Prisma Health experience. Interfaces with patients and physician office team members to accurately authorize various consultations, procedures and tests. Utilizes each patient's preferred method of contact. Utilizes various electronic medical records to transmit required clinical documentation to third party payors and Specialist Physicians. Responsibilities include documenting all actions and encounters regarding the referral including timely follow up with the patient, referring and referral physician practice and third-party payors including pre-certification, cancelled and rescheduled appointments, and other events preventing closure of the referral experience.
Accountabilities
Responsible for the authorization/precertification process to include coordinating with outside and internal organizations along with insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis and prognosis. Provides specific medical information to financial services to maximize reimbursement to the hospital and physicians.
Accurately records demographic, coverage, and scheduling information in various systems. Reminds patients of scheduled appointments via mail, internet, or telephone. Ensures that patient's primary care chart is up to date with scheduling information about specialist consults, tests, and procedures managed. Alerts management to trends in appointment availability and appointment date timeliness.
Promotes hospital goals towards meaningful use in the electronic medical record on behalf of the referring physician. Documents referral status and all scheduled appointments in appropriate system (electronic medical record) for referral tracking data. Responsible for following up after patient's consultation, procedure, and/or test to determine if physician has received report; continues to check on status until complete.
Serves as Liaison between the provider, practice, patient and specialist providing the service. Communicates Provides appropriate patient clinical information and referral needs to specialist office. Verifies physician's orders to ensure the accuracy of results and communicates with the patient the guidelines, protocols and location.
Assists patients in problem solving potential issues related to navigating the health care system, financial obligations or social barriers (e.g., request interpreters if appropriate, transportation services or prescription assistance). May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
Supervisory/Management Responsibilities
- This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Experience
High School diploma or equivalent Two (2) years of comparable experience, preferably in a physician front office to include patient registration and/or electronic scheduling and the authorization/precertification process.
In Lieu Of
Required Certifications, Registrations, Licenses
Knowledge, Skills or Abilities
Must have excellent customer service skills Excellent oral and written communication skills and interpersonal skills Knowledge of various health insurance companies. Knowledge of medical terminology, CPT and Diagnosis Coding, insurance verification and updates, and the authorization/precertification process. Knowledge of Microsoft office products. Must pass data entry test 85 kst. with 90% accuracy. Work Shift Day (United States of America)
Location Patewood Outpt Ctr/Med Offices
Facility 2116 Plastics Surgery - Patewood
Department 21161000 Plastics Surgery - Patewood-Practice Operations
Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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Prisma Health
Nov 15, 2024