REFERRALS REPRESENTATIVE
Company: Southern Illinois Healthcare
Location: Carbondale
Posted on: August 7, 2022
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Job Description:
Your Career. Our Company. Together, We Grow. - -At -Southern
Illinois Healthcare (SIH), -we realize that in order to provide our
surrounding communities with excellent care, we must begin by
providing our employees with that same care and appreciation. We
offer rich opportunities to develop and grow professionally, an
environment of excellence in patient care, and the awareness that
everything we accomplish is a direct outgrowth of the superb
efforts and dedication of our employees. -As a non-profit system of
almost 4000 employees, we have won national acclaim for our cancer,
cardiac, stroke, bariatric, breast imaging, and rehabilitation
services. -Responsible for patient prior authorization, patient
referrals including scheduling of internal referral and outgoing
patient referrals, documentation of status of prior authorizations
and referrals, ability to navigate registration, referral entries,
auth/cert entries and patient chart workflows in EPIC, ability to
update and confirm current patient insurance coverage and day to
day monitoring of all EPIC prior authorizations and referrals work
queues. Responsibilities --- - Monitors EPIC prior authorization
and referrals work queues daily --- - Classified insurance
approvals, based on physician orders, in order to expedite claim
processing. --- - Identify and prioritize urgent and emergency
prior authorizations and referral consultation requests --- -
Checks chart for relevant referral/prior authorization information
and shares with appropriate insurance provider or referring office
provider --- - Call or submit online request to insurance providers
for prior authorizations --- - Communicates details regarding
denials and peer-to-peer request for prior authorizations and
provider offices --- - Communicates effectively with patients,
provider staff and insurance providers by telephone and Epic
Inbasket --- - Follow through on referrals and prior authorizations
to completion/resolution in a timely fashion --- - Document
progress/status of prior authorizations and referrals on the EPIC
referral or EPIC auth/cert forms --- - Follow-up on missing
insurance documentation with patients --- - Schedules internal
referrals in EPIC directly onto the provider's schedule. --- -
Validates information for a prior authorization or referral request
and follows-up with providers office regarding missing CPT codes or
missing chart documentation --- - Collaborates with staff to
identify workflow problems and identify solutions --- -
Consistently looks for ways to streamline the prior authorization
and referrals process an improve the patient and staff experience
--- - Leads, tracks, monitors updates in insurance prior
authorization criteria and educate provider staff Qualifications
--- - High School Diploma or Equivalent. - -#PIQMedGrpPandoLogic.
Keywords: Referral Specialist, Location: Carbondale, IL - 62901
Keywords: Southern Illinois Healthcare, Evansville , REFERRALS REPRESENTATIVE, Other , Carbondale, Indiana
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