Referral Spec

Elevating the Possibility of U at UCHealth
UCHealth is a special place and it requires a special type of person to work here. We are committed to attracting exceptional people who possess a rare combination of talent, drive, and intellectual curiosity. They are the people who naturally gravitate toward our culture, our geography, and our passion for discovery -- ambitious people for whom UCHealth isn't just a career, but an elevated state of mind.
Summary
Primary responsibility is to ensure compliance with managed care, commercial insurance, and public insurance requirements. Duties include documentation, tracking, and submission of referrals in a timely manner to facilitate the appropriate care for members of health plans under contract by University Hospital and University Physicians, Inc. Coordinates tasks/teams within the department to achieve the departmental mission; assists in developing and implementing policies and procedures, methods, and standards; coordinates quality improvement processes and evaluates results. Provides a high standard of service excellence in a professional manner to internal and external customers; demonstrates a commitment to financial success of the organization; demonstrates organizational commitment through adherence to policies and procedures. Utilizes analytical and decision-making skills to provide the most efficient patient flow and the highest standard of service excellence.
Job duties
Documents all referrals submitted from or received in the practice. Verifies eligibility and benefits, and obtains authorizations for treatments and/or precertification of outpatient high cost drugs as required from health care plans. Must be familiar with diagnosis codes to ensure correct information is submitted to insurance companies for approval.
Tracks referrals to ensure compliance with Health Plan referral guidelines.
Responds to third party payors, employers, internal staff, and physicians in day-to-day customer service relations and problem resolution.
Works with Practice Manager, Practice Director, and providers to implement new Health Plan guidelines.
Interacts with patients, visitors and hospital staff in a courteous manner; demonstrates verbally and non-verbally a sincere initiative in facilitating the meeting of patients needs. Meets face-to-face standards in accordance with hospital and departmental policy. Adheres to hospital and departmental policies/expectations regarding professional manners, appropriateness of attire and use of language. Ensures confidentiality of patient and institutional material.
Answers the telephone promptly, routes callers, takes complete and accurate messages, provides routine information to customers, relays information to the appropriate person with accuracy, courtesy and speed and per hospital and departmental policies. Monitors patient needs and responds cordially to patient inquiries. Maintains neat, clean, and safe work area, working room and corridors.
Requirements
High School Diploma or equivalent
6 months of health care experience
Preferred
Associate's Degree
3 Years Medical Office/Managed Care/Insurance Experience
With award-winning hospitals and facilities serving the entire Front Range, University of Colorado Health is the state's largest and most innovative health system. By integrating the strengths of academic medicine with the finest community health care, we're able to push the boundaries of medicine and offer our employees endless career opportunities. Here, there are no limits, except those you place on yourself. Everyone is united by their passion for discovery and their commitment to improving patients' lives.
Join Us. Together We Improve lives.
The University of Colorado Health (UCHealth) system recognizes and appreciates the rich array of talents and perspectives that equal employment and diversity can offer our institution. As an affirmative action/equal opportunity employer, UCHealth is committed to making all employment decisions based on valid requirements. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the individual's race, creed, color, religion, gender, national origin or ancestry, age, mental or physical disability, sexual orientation, gender variance, genetic information or veteran status. UCHealth does not discriminate against any "qualified applicant with a disability" as defined under the Americans with Disabilities Act and will make reasonable accommodations, when they do not impose an undue hardship on the organization.

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