Patient Referral Representative - Ortho

Reviewing provider orders and/or requesting for patient services and determining appropriate referral, prior authorizations, and pre-certifications process per health plan requirements.  Consistently providing the highest level of customer service both on the phone and in person.

Reviews open status referral report/Epic work queues daily and processes referrals to approved, closed or incomplete status based on established policy.  

Ensures complete and accurate registration, including patient demographic and current insurance information. 

Addresses questions and concerns with patients regarding their referrals and sets guidelines and expectations about the EHV referrals process.  

Utilizes online tools to research criteria to verify insurance coverage and need for preauthorization.  

Communicates professionally with insurance companies, patients, primary care physicians, specialists and/or facilities regarding authorization as needed. 

Works with the provider to ensure the procedure has correct coding and is approved prior to initiation of procedure/test/treatment. 

Establishes, develops and maintains good working relationships with hospital departments, health plan representatives and physician office personnel to ensure timely transfer of information to complete the authorization process and promote goodwill.  

Documents all referral information in Epic. 

Ensures strict confidentiality of all health records, member information and meets HIPAA guidelines.

High School Diploma or GED

Minimum of two years of physician office or physician billing experience

Minimum of one year of customer service experience

Working knowledge of medical terminology or coding experience

Proficient keyboard and computer skills