Referral Specialist - Cancer Center - FT - Augusta, GA
Wellstar Health System
Summary
The Referral Specialist is responsible for handling the referral process for specialized procedures in the ambulatory setting, ensuring that appropriate authorizations are requested, received and recorded in tapestry. Acts as the primary source for staff regarding authorizations, insurance plans, and specific procedural codes. The job duties include tracking of the patients and ensuring follow through. This is a clerical position working in a clinic with multiple providers and support staff.
Job description
Job Summary
The Referral Specialist is responsible for handling the referral process for specialized procedures in the ambulatory setting, ensuring that appropriate authorizations are requested, received and recorded in tapestry. Acts as the primary source for staff regarding authorizations, insurance plans, and specific procedural codes. The job duties include tracking of the patients and ensuring follow through. This is a clerical position working in a clinic with multiple providers and support staff.
Core Responsibilities and Essential Functions
- Coordinates and processes authorizations
- Acts as the liaison between the specialist, primary care physician and insurance carrier to ensure appropriate authorization for specialty procedures
- Ensures all authorizations are requested with appropriate ICD9 / CPT codes and includes clinical data to support request
- Expedite the authorization process by monitoring and tracking the special procedure database (tapestry)
- Updates tapestry with valid authorization codes, date of service, and insurance contact information
- Tracks and monitors all clinic authorizations and referrals
- Documents referrals and all conversations regarding authorization request in the electronic medical record
- Responds to all patients insurance questions/concerns
- Responds to all required insurance data requests in a timely manner
- Advocate for, and generates appeals and troubleshooting patient needs
- Maintains utilization data on managed care patients
- Responds to all phone calls from patients, physician offices and insurance plans on referrals made
- Coordinates all aspects of managed care operations
- Coordinates review of all clinic authorizations with Patient Care Manager, Providers and support staff as necessary
- Researches patient eligibility and benefits; corresponding with patient accounts and faxing requested documentation
Requirements
- High School Diploma
- Minimum 2 years clerical experience
- Knowledge of and skill in the use of personal computer and related software
- Knowledge of medical terminology and medical ethics
- Time management, good grammar and spelling, good interpersonal skills
- Ability to deal with difficult people or situations in a professional manner
- Ability to train staff of all levels
- Ability to work efficiently under pressure, with a high degree of accuracy
- Ability to work independently and take initiative
- Ability to exercise discretion and maintain confidentiality
Company overview
Wellstar Health System is one of Georgia's largest and most comprehensive integrated healthcare systems, founded in 1993 and headquartered in Marietta, Georgia. As a non-profit health system, Wellstar operates with a mission to enhance the health and well-being of every person it serves through its PeopleCare approach. The system employs approximately 29,469 to 33,000 team members across multiple hospitals, health parks, medical offices, outpatient centers, pediatric centers, nursing facilities, and hospice and home care services. Wellstar is nationally recognized for operating Georgia's largest integrated trauma network and features the second-largest Emergency Department in the United States. The organization provides more than $1 billion annually in charity care and community programs, demonstrating its commitment to community health. Wellstar has earned numerous accolades including recognition on Fortune's 100 Best Companies to Work For, Best Workplaces in Health Care, and PEOPLE Companies that Care lists. The system embraces innovation through its venture firm Catalyst by Wellstar, which nurtures early-stage healthcare companies, and maintains academic partnerships with institutions like the Medical College of Georgia for caregiver training. With specialties spanning cardiovascular care, oncology, women's health, pediatrics, musculoskeletal services, and numerous other medical disciplines, Wellstar delivers comprehensive healthcare across all stages of life.