Referral Specialist

UnityPoint Health

Referral Specialist

Waterloo, IA

1.0 FTR (40 hours/week) Full time benefits

Monday - Friday 8am-4:30pm

**Position may sit remote in Cedar Rapids, Waterloo, Des Moines, Sioux City or Quad Cities**

Manage all facets of the patient referral process. The scope of the referral process begins with receipt from the provider through to the communication with the patient. Responsibilities include, but are not limited to, obtaining pre-certification or prior-authorizations, scheduling the visit with specialist or outpatient services, completion of documentation with the electronic medical record (EMR) and communicating referral information to referring offices and to the patient.

Why UnityPoint Health?

• Commitment to our Team – We’ve been named a  Top 150 Place to Work in Healthcare 2022  by Becker’s Healthcare for our commitment to our team members.
• Culture – At UnityPoint Health, you matter. Come for a fulfilling career and experience  a culture  guided by uncompromising values and unwavering belief in doing what's right for the people we serve.
• Benefits – Our competitive  Total Rewards  program offers benefits options that align with your needs and priorities, no matter what life stage you’re in.
• Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.
• Development – We believe equipping you with support and  development opportunities  is an essential part of delivering a remarkable employment experience.
• Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve.

Visit us at UnityPoint.org/careers to hear more from our team members about why UnityPoint Health is a great place to work.  https://dayinthelife.unitypoint.org/ 

Coordination of Patient Appointments & Authorizations

• Coordinates appointments and relays authorization information to scheduling staff of specialist or outpatient service offices as requested
• Completes appropriate forms or requisitions needed for referrals or testing, including appropriate CPT/ICD-10 coding
• Provides appropriate and timely documentation in the patient’s EMR using standardized workflows and processes.
• Builds and maintains positive working relationships with all contacts
• Acts as a liaison between UnityPoint and all referral sources

Correspondence with Patients

• Notifies patient of appointment details via telephone, MyChart, and letter.
• Ensure patients are informed of scheduled tests/procedures.
• Reinforces instructions and explanations of tests/procedures to patients per protocol
• Utilizes exemplary customer service skills with every patient interaction

Obtain Pre-Certifications and Prior Authorizations

• Obtains insurance pre-certifications and prior authorizations for office procedures, diagnostic testing, and imaging for patients
• Coordinates pre-certs and authorization processes with scheduling staff so appointments can be made in timely manner
• Obtains any and all pertinent clinic health information from provider, clinical staff and/or EMR to process authorizations, referrals, and pre-certifications.
• Verifies demographic information, including insurance, when scheduling and/or obtaining pre-certifications
• Monitors outstanding authorization requests and initiates follow-up of outstanding authorizations in a timely manner
• Maintains current knowledge of payer specific requirements of prior authorizations by attending virtual workshops, researching, reading newsletters

Education: High School diploma or equivalent. Graduate of accredited medical assistant, CNA and/or nursing program, preferred.

Experience: 2-3 years previous experience in medical field. Basic knowledge of medical terminology, anatomy and physiology. Experience with insurance verification/pre-authorizations, Basic knowledge of Current Procedural Terminology (CPT) and International Classification of Disease (ICD-10) coding, is preferred.

Knowledge/Skills/Abilities:

• Strong telephone and organizational skills and ability to interact effectively with internal/external customers.
• Writes, reads, comprehends and speaks fluent English.
• Multicultural sensitivity.
• Microsoft Office – basic computer skills.
• Customer/patient focused
• Critical thinking skills using independent judgment in making decisions.
• Ability to work as a team member.
• Ability to understand and apply guidelines, policies and procedures.