Referral and Insurance Specialist - Eastern Ohio Pulmonary

Thank you for considering a career at Mercy Health!

Scheduled Weekly Hours:

40

Work Shift:

Days (United States of America)

As a faith-based and patient-focused organization, Mercy Health exists to enhance the health and well-being of all people in mind, body and spirit through exceptional patient care. Success in this goal requires a culture of compassion, collaboration, excellence and respect. Mercy Health seeks people that are committed to our values of compassion, human dignity, integrity, service and stewardship to create an environment where associates want to work and help communities thrive.

Job Summary:

The Referral and Insurance Specialist obtains authorizations from insurance companies for referrals to physicians and/or procedures/testing. Verifies eligibility/coverage for referral via phone/fax/Internet. Schedule appointments for testing at medical facilities or appointments with physicians. Gathers charge information and enter all pertinent charge and patient demographic information into computer billing system. Post all payments and make daily deposits. Assist patients regarding billing questions and account balance resolution. Promotes a positive and helpful climate for good interpersonal and interdepartmental relationships.

Essential Functions:

• Obtains authorizations from insurance companies for referrals to physicians/medical facilities and/or procedures/testing.
• Schedules appointments for testing at medical facilities or appointments with physicians.
• Verifies eligibility/coverage for referral/testing via phone/fax/Internet.
• Investigates billing problems and denials.
• Notifies patients of referral process whether authorized or denied in a timely manner. Give patients instructions.
• Performs data input of patient and/or insurance changes and corrections to ensure current and accurate information in billing system.
• Answers the telephone, take messages, schedule appointments and greet patients as needed.
• Prepares patient charge encounter forms for each day and makes new or updates patient chart as needed.
• Oversees waiting area, coordinate patient movement, and reports problems or irregularities.
• Screens visitors and respond to routine request for information.
• Organizes and files progress notes, testing reports, and other forms necessary for chart completion. Assists with appropriate filing of patient charts as needed.
• Collects patient responsibility balances and copayments as needed. Balance money collected daily.
• Opens and distributes daily mail as needed
• Obtains authorizations from insurance carriers or pharmacy benefit managers for medications.
• Collects all daily charge slips from the physician and reconciles the number of charge slips and their totals
• Applies all payments to the appropriate patient account by posting each into the computer billing systems
• Inputs all charge information into the online billing system
• Assists with coding and error resolution as well as requesting needed information by working with the physician offices
• Works with patients in resolving billing questions and patient account resolution
• As applicable, reviews information to make determination on the appropriate course of action for the patient, makes referrals to the local DSS office as appropriate.

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Education:

High School Diploma or GED (required)

Licensure/Certification:

None

Experience:

2-3 years of experience in a related medical field with experience in processing referrals (preferred)

Mercy Health is an equal opportunity employer.

As a Mercy Health associate, you’re part of a Misson that matters. We support your well-being – personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way. 

• What we offer
•     Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
•     Medical, dental, vision, prescription coverage, HAS/FSA options, life insurance, mental health resources and discounts
•     Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
•     Tuition assistance, professional development and continuing education support

Benefits may vary based on the market and employment status.
 

Department:

Boardman Pulmonary - MHP - Youngstown Specialty Care

It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). Accordingly, all applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health– Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employer, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com.