Referral Representative, Full time, Day/Eve

Job Description

Overview

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.

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.

EEO/AA/Disability/Veteran

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.
• 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.
• 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.
• 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.
• 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.
• 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.

Qualifications

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. The applicant must possess a refined customer service skill set and be able to relay this attribute to the patient population. Demonstrate the ability to multitask in a fast paced environment, through the utilization of EPIC or additional computer systems, in order to facilitate an efficient scheduling and pre-registration/registration workflow. Exhibit a comprehensive understanding of the various insurance carriers and possess the ability to interview patients or family representatives.

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.