Do you love helping people? Do you enjoy working with a fun, outgoing team committed to making a difference in the world?
Then Adelante Healthcare wants to talk to you about becoming a Referral Representative at our beautiful new Central Phoenix Call Center.
The right candidate will be an enthusiastic in addressing callers’ needs and ready to take on new challenges. Referral Representatives will manage referrals to external specialties, connect with insurance companies and triage questions on medical matters to help the 70,000 patients who use our nine community health centers be their healthiest.
Adelante is growing fast and we want you to grow alongside us. Some basic experience is required, but we will equip you with all the tools you need to become an expert in this role--while also providing you the building blocks to reach your next one.
Don’t miss out on this chance to begin a successful career in the healthcare industry while also enjoying great benefits like three weeks of paid time off and an amazing team environment. Apply on-line today!
The Referrals Representative is responsible for processing patient referrals for an assigned site. Responsible for coordinating specialty referrals and diagnostic testing. Pre-certifies diagnostic testing, as required by patient's insurance. Educates the patients on various policies, procedures, and benefits, related to the need for referrals. Assists patients over the phone with scheduling support for medical and gynecological/obstetrics, relaying medical information and/or medical and referral information request. Coordinates referrals with patients and specialist's offices, and process insurance referrals as required. Acts as a liaison between patient, physician and insurance company, consistently performing activities in a friendly, courteous and professional manner.
- Initiates and manages clinical referrals for pre-authorization
- Acts as a liaison between health plans, physicians, patients and other referral sources
- Obtains authorization on for admissions as required by health plans
- Reviews referrals for completeness and follows up for additional information if necessary
- Process an average of 40 referrals daily
- Responds to inbound calls initiating exam requests following established processes, meets quality and production standards
- Contacts physician offices as needed to obtain demographic information or related data
- Enters referrals, documents communications and actions in system
- Enters patient insurance authorizations and any pertinent information from insurance company into the patient account history
- Manages denials or potential denials as described by insurer
- Monitors and reviews applicable schedule to ensure that authorization and initial length of stay is obtained and on file
- Responsibilities may vary over time. Required to perform other duties as required for the efficiency and effectiveness of the department and job role
- Ensure patient needs and requests are handled efficiently by performing telephonic patient scheduling
- Schedule patient initial and follow up appointments ensuring efficient use of provider time and the appropriate care for patients
- Perform patient pre-registration including accessing and updating patient information as indicated
- Maintain schedule accuracy for maximum patient flow
- Follow established procedures for answering and screening incoming appointment-related telephone calls, scheduling interpreters, and directing calls to appropriate staff
- Maintain effective communication with office staff and providers in all of the health centers as needed
- Maintains good attendance, is punctual and works full scheduled shift
- Demonstrates respectful, professional and appropriate behavior that supports a team oriented work environment
- As needed will be utilized as back-up for the patient support center
Additional Duties and Responsibilities
- Other duties as requested or assigned
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job related selection or promotional criteria.
In any organization or job, changes take place over time. Although an effort will be made to keep job-related information current, this is not an all-inclusive list of job responsibilities. Adelante Healthcare, Inc. reserves the right to revise or change job duties and responsibilities as the business need arises. In compliance with EEOC 29 CFR part 1630, if the essential functions of this position cannot be performed in a satisfactory manner by the employee, further accommodations shall be made if it does not constitute undue hardships upon this organization.