**WFH opportunity*

POSITION DESCRIPTION:

This position is responsible for all aspects of the referral process, which may vary depending on practice/department specialty. May perform Medical Receptionist duties as necessary.

ESSENTIAL JOB FUNCTIONS:

1. Educates patients and staff with pertinent referral and insurance information.
2. Obtains pre-certifications and insurance authorizations for medical procedures.
3. Generates referral information for physicians, patients and health plans.
4. Acts as a liaison among providers, patients and health plan administrators.
5. Relays clinical information to health plan case managers for special procedure pre-certification and out-of-plan or out-of-network referrals; monitors authorizations or denials and follows up as necessary.
6. Communicates referral status to patients and physicians; ensures that referrals have been processed accurately and in a timely manner to coincide with patient treatment plan.
7. Assists patients in scheduling appointments with specialists, resolving billing discrepancies and any other referral issues.
8. Supports other offices, attends required meetings and training, and participates in committees as requested.
9. May perform Medical Reception duties as necessary.
10. Assists with special projects and assumes additional duties as assigned.

ORGANIZATIONAL EXPECTATIONS:

1. Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of both IHA and Trinity Health.
2. Must be able to work effectively as a member of the reception team.
3. Successfully completes IHA’s “The Customer” training and adheres to IHA’s standard of promptly providing a high level of service and respect to internal or external customers.
4. Maintains knowledge of and complies with IHA standards, policies and procedures.
5. Maintains complete knowledge of office services and in the use of all relevant office equipment, computer and manual systems.
6. Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines
7. Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences.
8. Uses resources efficiently.
9. Monitors, organizes and keeps work area and waiting room neat.

MEASURED BY:

Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.

ESSENTIAL QUALIFICATIONS:

EDUCATION: Undergraduate degree or Associate’s degree in health care or a related field and specialized training or equivalent combination of education and experience.

CREDENTIALS/LICENSURE: None

MINIMUM EXPERIENCE: 4 years’ experience with insurance referrals, prior authorization or other relevant medical office experience.

POSITION REQUIREMENTS (ABILITIES & SKILLS):

1. Knowledge of medical terminology and procedures at the level needed to perform responsibilities.
2. Proficient knowledge of major health plans and insurance processes.
3. Excellent written (legible), verbal and face-to-face communication skills, including ability to effectively explain relevant insurance information to patients, as well as communicate with insurance plans and internal customers. Proper phone etiquette.
4. Proficient/knowledgeable in patient care procedures and organizational policies related to position responsibilities.
5. Service-oriented; responsive to customer needs and courteous in approach.
6. Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, NextGen, Microsoft Word /Excel/Outlook, intranet and computer navigation.
7. Ability to compute mathematical calculations.
8. Ability to work independently and collaboratively in a team-oriented environment; displays professional and friendly demeanor.
9. Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, patients, family members, vendors, outside customers and couriers.
10. Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.
11. Good organizational and time management skills to effectively juggle multiple priorities and time constraints.
12. Ability to exercise sound judgement and problem-solving skills.
13. Ability to handle patient and organizational information in a confidential manner.
14. Ability to travel to other office/practice sites and meeting and training locations.
15. Successful completion of IHA competency-based program within introductory and training period.

MINIMUM PHYSICAL EXPECTATIONS:

1. Physical activity that often requires keyboarding, filing and phone work.
2. Physical activity that often requires extensive time working on a computer.
3. Physical activity that sometimes requires walking, standing, bending, stooping, reaching, and/or twisting.
4. Physical activity that sometimes requires lifting, pushing and/or pulling under 30 lbs.
5. Specific vision abilities required include close vision, depth perception, peripheral vision and the ability to adjust and focus.
6. Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
7. Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.

MINIMUM ENVIRONMENTAL EXPECTATIONS:

This job operates in a typical office environment with some exposure to contagious diseases/viruses. It requires significant interaction with people (many of whom are scared, hurt and/or ill) which can be stressful and result in competing priorities.