| Primary City/State: Phoenix, Arizona Department Name: Work Shift: Day Job Category: Administrative Services At Banner - University Medical Group (BUMG), we're creating a world class medical organization that brings together a leadership team committed to a physician-focused structure, while navigating the challenges of moving from a volume-based to value-based health care system. As a Referral Specialist on this team, you will use your experience in a busy healthcare/medical office environment processing patient referrals and insurance information. Excellent customer service and communication skills are a must! Here is a listing of the BUMG-Phoenix clinics that may be hiring for qualified Referral Specialists: Ortho/Sports Medicine Institute Rheumatology Clinic Neuroscience Institute Diabetes and Endocrine Clinic Family Medicine Clinic Bariatric Clinic Lung Institute Heart Institute Digestive Health Toxicology Internal Medicine Behavioral Health Infectious Disease Rheumatology Endoscopy Musculoskeletal Concussion Clinic Integrated Surgery Urology Oral Maxillofacial Surgery Heart Failure Clinic Wound Care Clinic Advanced Liver Disease Clinic Trauma Services Adult Sickle Cell Clinic All of these clinics are located within walking distance to the Banner University Medical Center in Phoenix (located near 12th and McDowell). While the start and end times can vary slightly, these are full time (40 hours/week), day shift positions: Monday-Friday 8A-5P being the most common shift. POSITION SUMMARY
This position is responsible for coordinating referral orders for a continuation of treatment, such as specialty services and diagnostic testing within a primary care practice. This position provides all pertinent clinical information needed for the payor authorization and the facility or specialist prior to the services being rendered. The position is responsible for tracking and managing all referrals with the intention and outcome to close any patient care gaps, along with providing documentation to promote team awareness.
CORE FUNCTIONS
1. Schedules appointments for specialty physician services and diagnostic testing per provider request and communicates with the patient on a timely basis for all scheduling requirements
2. Acts as a liaison between patients, providers and staff members for patients' referral and follow up needs. Provides prompt and professional service for the patients by assisting in educating patient/family and assisting patients with external resources when needed.
3. Provides all pertinent clinical information needed for the payor authorization, the facility or specialist prior to the services being rendered by verifying coverage, obtaining authorization and communicating with receiving facilities
4. Tracks and manages all referrals by monitoring outstanding referrals at 30/60/90 day intervals and following up with patients if appointments are not kept
5. Applies knowledge of medical terminology and maintains up to date knowledge of insurance environment. Utilizes internal and external resources to seek knowledge about regulations regarding various payor sources
6. Collaborates with outside referral sources and other community resources. Maintains an updated list of community resources and networks with colleagues to develop additional referral sources
7. This position has frequent communications with patients, physicians, staff, and third party payers. The position must work with and understand the concepts of managed health care and be able to prioritize tasks within established guidelines with moderate supervision
MINIMUM QUALIFICATIONS
High school diploma/GED or equivalent working knowledge.
Possesses 1 year of direct patient interaction/experience in a medical, insurance, or healthcare related industry. Knowledge of HIPAA regulations. Strong customer service focus and willingness to problem solve. Effective verbal and written communication skills and the ability to manage competing priorities. Must be proficient with commonly used office software.
PREFERRED QUALIFICATIONS
Previous knowledge of managed care concepts. Working knowledge of medical terminology and ICD-9 and CPT codes.
Additional related education and/or experience preferred. | 
