Clinical Referral Specialist - Mary Rutan Hospital

• Job Summary

  • The primary responsibility of this role is the coordination of referrals to and from Mary Rutan Health’s practices and clinics to other sites of care. They will contact insurance companies, physicians, and patients to ensure that pre-certification and/or pre-authorization determination can be made for scheduled services, that all necessary documentation is on file to prepare for scheduling and appointments and may help with navigation to the most appropriate provider or care setting. To achieve these responsibilities the duties may include, but are not limited to:

    • Act as a liaison between hospitals, clinical staff, health plans, providers, and patients to process referrals.
    • Verify insurance coverage and assist with authorizations as needed.
    • Gather pertinent information from patients, medical offices, insurance carriers, and other staff.
    • Document referrals, communications, actions, and other data in the hospital’s EMR.
    • Generate and distribute all applicable forms, notifications, and paperwork.
    • Ensure timely response to customer needs, including both internal and external customers.
• Regulatory Requirements
  • MINIMUM EDUCATION REQUIRED: High school degree or GED.
  • MINIMUM EXPERIENCE REQUIRED: A combination of four (4) previous years of: related healthcare administrative experience specifically with precertification/authorizations, physician or hospital referral management, or medical office operations; or related healthcare clinical experience.
  • ADDITIONAL PREFERRED QUALIFICATIONS: Experience with Meditech Electronic Medical Record (EMR); experience in an off-site setting supporting multiple medical practices; Licensed Practical Nurse or higher level of nursing education (active in state of Ohio) or alternative clinical certification (pharmacy tech, rad tech, etc.)
• Language Skills
  • Ability to communicate in English, both verbally and in writing.
  • Additional languages preferred.
  • Excellent interpersonal skills.
• Skills
  • Excellent written, verbal communication and interpersonal skills.
  • Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment.
  • A demonstrated ability to use PC based office productivity tools (e.g. Microsoft Outlook, Microsoft Excel) as necessary; general computer skills necessary to work effectively in an office environment.
  • Dedication to treating both internal and external constituents as clients and customers, maintaining a flexible customer service approach and orientation that emphasizes service satisfaction and quality.

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