Company: Catholic Health Initiative
Posted on: January 11, 2021
Dr. Harless, MD
Mountain Management Services provides planning, management,
billing, and design services to hundreds of physicians in the
Southeast Tennessee and Northwest Georgia. We offer a wide range of
services, each with the objective of providing our clients with
comprehensive management resources and enabling them to have the
peace of mind and assurance that the health of their practices is
not left to chance.
The Referral Specialist works with patients requiring a referral
for a test or to a specialist office, to ensure patient's referral
needs are fulfilled for tests and specialty service office visits.
Processes orders for tests and referrals, authorizations and
pre-certifications for patients, to ensure timely reimbursements.
Follows up on all test and referrals to specialist office until the
documentation is received and scanned into the system for
Essential Key Job Responsibilities
* Gather, verify, and process orders for test, referrals,
authorizations, and pre-certifications by working closely with
physician(s), patients, and payers.
* Communicate detailed information and answers patients' questions
regarding their health care plan; provide answers to billing and
insurance clarification questions.
* Set up appointments, coordinate clinic visits, and any special
arrangements such as transportation, interpreter services,
specialty care, etc.
* Communicates or gives written material to patients with referral
information such as date, time, and location, as well as contact
information to ensure patient has resources to review if
* Coordinate flow of information between medical clinic and
patients insurance for referral authorization to secure a valid
referral for clinic patient.
* Enter and annotate testing information and referrals, does
e-referral for applicable practices for meaningful use and
follows-up to make sure e-referral and or faxed referrals are
received, documents communications and action into PPMS and AEHR,
* Maintains supply of contrasting prep for testing so that when
patients are scheduled the prep can be given to the patient and the
patient can be educated as to the prep. Otherwise patients are told
to be at the testing site 1 hours early for prep.
* Notify physician(s) and patient when test or referral is denied,
or if additional information is needed.
* Develop and maintain database of referral physician offices
preferred by each physician within the clinic.
* Maintains complaint resolution and solutions related to patient
referrals. Calls or faxes for test and referral documents,
documents in notes when attempts are made to reconcile the test or
referral. Scans the documents into the system and closes the order
or referral. Documents all test and referrals in PPMS and AEHR for
* Knowledge of clinic referral and scheduling processes and
* Knowledge of federal and state pay requirements, including
Medicare, DSHS, HMO/PPO Contracts.
High school diploma or equivalent required.
* 2 years of progressively responsible related experience in a
healthcare office environment specializing in the referral process
* Experience in AEHR and PPMS systems is preferred.
Keywords: Catholic Health Initiative, Chattanooga , Referral Specialist, Other , Chattanooga, Tennessee
Didn't find what you're looking for? Search again!