Northern Light A.R. Gould Department: Physician Practice Central Ops Position is located: Northern Light Health Center Fort Fairfield Work Type: Full Time Hours Per Week: 40.00 Work Schedule: 8:00 AM to 4:30 PM Summary: Referral specialists are responsible for assuring that patients needing diagnostic tests and specialty services are referred to the appropriate department/office efficiently to assure services needed are received timely. They assist with insurance prior authorizations. The role of the referral specialist is critical to assure that every patient receives the definitive care that they need. Key characteristics to be successful include expert communication, knowledge of insurances and health systems, teamwork, collaboration, organizational skills, and detail orientation. Multitasking ability is essential as Referral Specialists often are working on multiple cases at a time. Fast paced setting requires independent thinking, ability and willingness to be flexible and adaptable to changes. Re-prioritization of tasks occurs frequently. Responsibilities: Manages outgoing referrals and incoming referrals as assigned. Obtains authorizations for procedures and diagnostics as assigned. Communicates with patients, providers, office staff, insurers, and referrers. Works collaboratively with clinical staff, providers, surgical schedulers, ancillary departments, and insurance carriers to complete work. Adds new patients to EMR when needed, including assisting with scheduling as assigned. Manages and monitors prior authorizations/out-going referrals for the assigned department(s) following Policy and Procedures. Maintains working knowledge of inpatient vs. outpatient procedures and CPT codes. Maintains referral tracking documentation to determine that referral is complete. Maintains current knowledge of various insurance processes necessary to obtain prior authorization; follows Prior Authorization Policy. Assists with claim denials/research as assigned. Assists with coding to assure appropriate authorization of procedures. Makes recommendations for change to improve processes in accordance with mission statement and established goals. Ensures compliance with Medicare and third-party payers procedures. Maintain safety standards at all times and report safety issues immediately. Maintains mandatory education compliance. Competencies and Skills: Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation. Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation. Exercises Sound Judgment&Decision Making: Understands and processes complex information, allowing for appropriate conclusions. Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results, and behaviors. Practices Compassion: Exhibits genuine care for people and is available and ready to help. Education: Required: Associate's Degree in business management, healthcare, administration, medical coding, or related field or 2 years’ experience in a medical office or related setting is required. Working Conditions: Prolonged periods of sitting. Lifting, moving and loading less than 20 pounds. J-18808-Ljbffr