Referral Representative

Greenwich, CT
Nov 8, 2018

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Job Description

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
EEO/AA/Disability/Veteran

THIS POSITION IS COVERED BY THE TEAMSTERS COLLECTIVE BARGAINING AGREEMENT Minimum - Maximum -

Summary:
Performs a variety of patient access functions to review, process and ensure timely completion of referrals to follow-up specialty outpatient care/services for Primary Care Center (PCC) patients, and to ensure appropriate reimbursement for services provided. Ensures completion of referral process for multiple services referred by assigned area of PCC (Women's Center, Pediatrics, or Adult Medicine) by obtaining, verifying information and signatures from providers and patients in accordance with third party payor requirements. Ensures positive interactions with patients, family members, medical staff, third party representatives and hospital personnel. Promotes good customer service in the work environment. Effectively utilizes all computer systems to ensure that the responsibilities of the Registration Department are met. Performs certain statistical and QA functions. Helps develop new procedures and participates in the planning and implementation of system improvements to enhance the operating functions of the department.
Responsibilities:
  • 1. PROVIDER INFORMATION: Ensures all required information is obtained from the referring physicians and providers in clinical areas, and provided to the third party payors to ensure reimbursement for services delivered within the outpatient setting.
  • 1.1. Develops and maintains knowledge of and effectively utilizes resources to understand the requirements of third party payors and managed care programs.
  • 1.2. Reviews referrals for completeness and follows-up when clinical information is incomplete.
  • 1.3. Ensures all referrals, pre-authorizations, and pre-certifications are received prior to services being rendered.
  • 1.4. Obtains required signatures to ensure compliance of time sensitive documents.
  • 1.5. Works with outside departments/clinics/physician offices to identify issues and solutions to problems in obtaining information required by third party payors.
  • 2. PATIENT INFORMATION: Reviews and ensures all patient information required by third party payors is obtained to ensure reimbursement
  • 2.1. Verifies current patient demographic, insurance and financial data; enters and/or updates all pertinent information into the registration and billing systems in a timely manner.
  • 2.2. Assembles and organizes documents as required by departmental procedure to ensure timely processing of the patients' medical records. Demonstrates a thorough understanding of all reports worked.
  • 3. PATIENT SCHEDULING: Demonstrates and applies sound knowledge of policies and procedures, as well as of the scheduling and registration process.
  • 3.1. In accordance with established policies and procedures, schedules clinic appointments.
  • 3.2. Incorporates physician preferences in the scheduling process.
  • 3.3. When appropriate, communicates booking and scheduling information to customers, patients, co-workers and others.
  • 4. INFORMATION SYSTEMS: Maintains knowledge and effectively utilizes multiple computer information systems (e.g. registration, scheduling, accounts receivable, patient care, patient tracking and Web based on-line eligibility systems) to determine status of pending referrals, schedule appointments, answer questions and resolve problems for patients, providers and third party payors.
  • 4.1. Participates in internal and external committees related to the enhancement or development of computer systems.
  • 4.2. Works with Logician team to ensure quality of information.
  • 4.3. Works with management staff to update procedures. Recognizes when to make workflow changes and when to escalate issues appropriately.
  • 4.4. Identifies and resolves information discrepancies between various software applications. Monitors, evaluates and responds to system abnormalities.
  • 5. QUALITY IMPROVEMENT: Participates in ongoing quality improvement efforts of the department, utilizing good problem solving methods and resourcefulness to address or resolve problems or to refer them to the appropriate person or department for resolution.
  • 5.1. Provides formal and informal training and education of medical staff and care providers regarding third party payor documentation and reimbursement requirements for referrals.
  • 5.2. Identifies and resolves problems with accounts that are encountered during the referral process, or refers them to appropriate person or department for resolution.
  • 5.3. Maintains statistical information, and prepares reports as requested.
  • 5.4. Participates in clinical meetings, as requested, to assist in the development of all clinic protocols and initiatives (e.g. standard forms & letters, information requirements of carriers, etc.) pertaining to reimbursement for outpatient services provided to patients based upon PCC referrals.
  • 5.5. Works closely with management when developing and implementing operating procedures as they relate to the area.
  • 5.6. Identifies and implements processes that will enhance the scheduling and registration process. Provides documentation of problems and their outcomes.
  • 6. CUSTOMER SERVICE: Works with manager, physician and other staff to create for the patient/family an experience that exemplifies caring, understanding, efficiency and overall quality of service.
  • 6.1. Demonstrates the ability to balance customer service with the financial needs of the hospital.
  • 6.2. Suggests and implements changes to enhance customer service.
  • 6.3. Balances the needs of the customer with the productivity of the department.
  • 6.4. Contributes to a positive work environment by actively discouraging 'we versus they' thinking.
    Other information:

    EDUCATION:

    High School graduate with demonstrated continuing education at a college level program or equivalent experience. Bachelor's Degree preferred.

    EXPERIENCE:

    Three or more years experience in a hospital Scheduling or Registration Department with emphasis on scheduling, registration and/or patient tracking functions. Experience should involve compliance with admitting and transfer policies as noted in the medical by-laws and the clinical necessity of admissions, as well as medical insurance and eligibility requirements.

    SPECIAL_SKILLS:

    word processing and spreadsheet applications in a Windows environment (Microsoft Word and Excel preferred); electronic patient medical record, scheduling and billing computer applications (Logician, SDK, EPIC, and IDX preferred). Ability to search internet and utilize web-based on-line eligibility systems to obtain third party payor information and requirements. Must be able to work under constant pressure and use strong organizational skills.
    ACCOUNTABILITY:

    accuracy and timeliness of scheduling, patient registration; thoroughness of all required documentation; monitoring the flow of information between multiple computer systems and deciding when to use back-up systems; obtaining needed demographic, clinical and financial information to ensure that patients are registered properly; adherence to established departmental guidelines, hospital policies and medical staff by-laws, as appropriate. Assumes responsibility for outpatient registration workflow, and assists other staff members with problem resolution within the department during the absence of Manager and Patient Account Representatives.
    COMPLEXITY:

    Position requires application of a variety of policies and procedures in dealing with employees, patients, families, physicians and their staffs. The incumbent's ability to correctly ensure completion of the referral process, and to collect, correct and complete insurance and demographic information directly affects reimbursement from third party payors. Due to the complexity and diversity of the interaction with various disciplines, the incumbent must have the ability to assess situations and make sound judgments in rectifying issues pertaining to referrals. Because the incumbent works with multiple computer systems, the incumbent must have the ability to understand how the systems interface with each other and how the integrity of information affects the patient, the clinician and reimbursement. Must be capable independently interpreting and applying established policies and procedures to individual situations when dealing with clinical staff, patients and families. Maintains a variety of statistical reports to track quality assurance, customer service and employee productivity.
    PHYSICAL_DEMAND:

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    Job Info

    Job: 2870

    Department: Access Operations G
    Category: Pt Fin Admit Svc
    Status: Part Time No Benefits
    Shift: WEEKEND EVENINGS
    Hours: 16.00