Arranges referral appointments for specialists utilizing managed care guidelines and practices. Maintains working knowledge of, and adheres to compliance with, Medicare, Medicaid, and managed care regulations.
1. Arranges referrals as indicated by the provider, utilizing proper insurance referral guidelines and CPT, ICD9 and HCPCS coding. May be required to send necessary lab and ancillary reports.
2. Verifies insurance information, current PCP, and medical necessity for the referral. Obtains authorization for release of medical records.
3. Obtains insurance pre-certification and authorization as required by the various insurance plans. Notifies the ordering provider of any conflict or delay in scheduling.
4. May schedule testing, make necessary appointments, document in the patient's chart and notify the patient of the appointment and necessary special instructions.
5. Pulls and retrieves files as required. Routes charts back to dictation area or file as indicated.
6. Answers telephones, routes messages and redirects as necessary.
7. Maintains referral log and verifies that patient completed appointment; verifies receipt of specialists consult notes and/or follows up with specialist if needed.
8. Follows the CHRISTUS Provider Network guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
9. Maintains strict confidentiality.
10. Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the CHRISTUS Mission.
11. Maintains established CHRISTUS Provider Network policies, procedures, objectives, quality assurance, safety, environmental and infection control.
12. Implements job responsibilities in a manner that is consistent with the CHRISTUS Mission and Code of Ethics and supportive of CHRISTUS Provider Network's cultural diversity objectives.
13. Supports and adheres to CPN Service Guarantee.
14. Performs other related work as required.
High school graduate or GED. Prefer one year work experience in a medical office setting. Knowledge of medical terminology and CPT, ICD9 and HCPCS coding necessary. Word processing and computer experience desirable. Ability to use various office equipment such as copiers, fax machines, and credit card machines. Excellent interpersonal skills and ability to communicate well. Must be organized with ability to perform multiple tasks in a busy environment. Knowledge of managed care contracts preferred
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.