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Referral Specialist

Mountain Management Services Chattanooga, Tennessee
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The posted compensation range of $15.00 - $20.33 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.

Requisition ID 2024-379077 Employment Type Full Time Department Thoracic Hours/Pay Period 80 Shift Day Weekly Schedule Monday - Friday (9:00am - 5:00pm) Remote No Category Administrative and Clerical
Overview

CHI Memorial Thoracic Oncology Associates

CHI Memorial Hospital, now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI) and Dignity Health, is once again the only hospital in the Chattanooga area to be named a Best Regional Hospital by U.S. News & World Report. We are proud to be the regional referral center of choice providing health care throughout Southeast Tennessee and North Georgia.

We care about our employees’ well-being and offer benefits that complement work/life balance.

We offer the following benefits to support you and your family:

Free Membership to our Care@Work program supporting any child care, pet care, or adult dependent needs

Employee Assistance Program (EAP) for you and your family

Health/Dental/Vision Insurance

Flexible spending accounts

Voluntary Protection: Group Accident, Critical Illness, and Identity Theft 

Adoption Assistance

Paid Time Off (PTO) 

Tuition Assistance for career growth and development

Matching Retirement Programs

Wellness Program

If you are passionate about the patient experience and ready to join our nationally recognized hospital, connect with us today!


Responsibilities

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 reconciliation.

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 needed.
  • 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, as appropriate.
  • 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 ½ 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 outmigration reporting.
  • Knowledge of clinic referral and scheduling processes and billing/authorization requirements.

Qualifications

Education:

  • High school diploma or equivalent required.

Qualifications:

  • 2 years of progressively responsible related experience in a healthcare office environment specializing in the referral process is preferred.
  • Experience in AEHR and PPMS systems is preferred

Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.

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Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible employees may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit https://www.commonspirit.careers/benefits.

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Equal Opportunity

CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here [PDF].

CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.