This position is responsible for coordinating the entire referral process (obtaining order from physician, obtaining insurance authorization from the insurance company/payor, scheduling the appointment for the patient with a physician who accept the particular insurance, notifying the patient of the appointment, completing renewal authorizations with physicians office and payor) for a 35 physician practice. Researches problem referral claims or requests for payment and corrects. Ensures physicians coding and Dx are appropriate for proper referral and coverage by insurance company. This position is also responsible for knowing various insurance plans and coverages for the patient to ensure proper payment. Responsible to teach nursing associates and physicians all changes within insurance plans for referral and authorization process. Must be up to date with all CPT and ICD-9 coding to process proper referral. Must have clinical background knowledge to appropriately support referral when communicating with insurance companies.
High School diploma or equivalent is required
Minimum three (3) years office experience in a healthcare setting required
Expert knowledge of managed care benefit plans with at least one (1) year specializing in a referral-based clinic or physicianâ€™s office.
Must have excellent customer service skills, communication with all customers (physicians, patients, insurance companies, staff, etc).
Bilingual (English and Spanish) is preferred.
Must be able to deal with stress and handle difficult patients with tact and courtesy.
Must be computer literate.
Experience with billing and collections for physician office practice required.
Must understand importance of patient confidentiality, and adhere to confidentiality expectations at all times.
Must be able to work independently, with little or no direct supervision. Must be able to follow instructions accurately.
Medical assistant certification from an approved technical school preferred.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.