Referral Specialist processes insurance pre-verification for hospital admissions or specialty service office visits. Gathers pertinent information from patients, insurance carriers, financial counselors, and other staff to confirm the patient's financial obligations for services. Being a Referral Specialist acts as a liaison between hospitals, clinical staff, health plans, providers, and patients to process referrals. Verifies insurance coverage and obtains required authorizations when necessary. Additionally, Referral Specialist documents referrals, communications, actions, and other data in an information management system. Generates and distributes all applicable forms, notifications, and paperwork. Requires a high school diploma. Typically reports to a supervisor. The Referral Specialist works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Referral Specialist typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
JOB PURPOSE OR MISSION : Communicates and interprets GHS policies and procedures to management and employees, increasing understanding of and compliance. Develops, maintains and/or changes processes and/or policies that promote efficiency and accuracy of GHS functions, for assigned area(s).
PERFORMANCE CRITERIA
CRITERIA A: Everyday Excellence Values - Employee demonstrates Everyday Excellence values in the day-to-day performance of their job.
PERFORMANCE STANDARDS: Demonstrates courtesy and caring to each other, patients and their families, physicians, and the community. Takes initiative in living our Everyday Excellence values and vital signs. Takes initiative in identifying customer needs before the customer asks. Participates in teamwork willingly and with enthusiasm. Demonstrates respect for the dignity and privacy needs of customers through personal action and attention to the environment of care. Keeps customers informed, answers customer questions and anticipates information needs of customers
CRITERIA B: Corporate Compliance - Employee demonstrates commitment to the Code of Conduct, Conflict of Interest Guidelines and the GHS Corporate Compliance Guidelines.
PERFORMANCE STANDARDS Practices diligence in fulfilling the regulatory and legal requirements of the position and department. Maintains accurate and reliable patient/organizational records. Maintains professional relationships with appropriate officials; communicates honesty and completely; behaves in a fair and nondiscriminatory manner in all professional contacts.
CRITERIA C: Personal Achievement - Employee demonstrates initiative in achieving work goals and meeting personal objectives.
PERFORMANCE STANDARDS Uses accepted procedures and practices to complete assignments. Uses creative and proactive solutions to achieve objectives even when workload and demands are high. Adheres to high moral principles of honesty, loyalty, sincerity, and fairness. Upholds the ethical standards of the organization.
CRITERIA D: Performance Improvement - Employee actively participates in Performance Improvement activities and incorporates quality improvement standards in his/her job performance.
PERFORMANCE STANDARDS Optimizes talents, skills, and abilities in achieving excellence in meeting and exceeding customer expectations. Initiates or redesigns to continuously improve work processes. Contributes ideas and suggestions to improve approaches to work processes. Willingly participates in organization and/or department quality initiatives.
CRITERIA E: Cost Management - Employee demonstrates effective cost management practices.
PERFORMANCE STANDARDS Effectively manages time and resources Makes conscious effort to effectively utilize the resources of the organization material, human, and financial. Consistently looks for and uses resource saving processes.
CRITERIA F: Patient & Employee Safety - Employee actively participates in and demonstrates effective patient and employee safety practices.
PERFORMANCE STANDARDS Employee effectively communicates, demonstrates, coordinates and emphasizes patient and employee safety. Employee proactively reports errors, potential errors, injuries or potential injuries. Employee demonstrates departmental specific patient and employee safety standards at all times. Employee demonstrates the use of proper safety techniques, equipment and devices and follows safety policies, procedures and plans.
JOB FUNCTIONS
ESSENTIAL JOB FUNCTIONS include, but are not limited to:
1. Serves as resource and customer/employee relations representative for the System.
PERFORMANCE STANDARDS: Receives employee, manager and/or external requests for information and/or assistance in resolving issues, using proper telephone/customer service techniques. Provides information and/or resolves issues within scope of own knowledge and authority, within established timeframes, maintaining communication with customer throughout process. Forwards other requests/issues to appropriate person(s), maintaining ownership of issue until final resolution is obtained. Serves as employee/customer advocate to create, maintain and foster an environment that embodies GHS principles.
2. Facilitates the dissemination of information to GHS employees and/or regulatory agencies and works a closely with the MIS team to ensure project completion. PERFORMANCE STANDARDS: Maintains structures in the HRIS System to accurately reflect the current GHS organizational configuration. Responsible for working with MIS team to ensure Human Resource needs are met. Designs and develops queries and reports, accurately providing customers with necessary data within established timeframes. Compiles and supplies information to customers on an ad hoc basis as needed.
3. Coordinates and oversees the daily operation of assigned HR staff. PERFORMANCE STANDARDS: Communicates and interprets GHS policies and procedures to management and employees, increasing understanding of and compliance. Develops, maintains and/or changes processes and/or policies that promote efficiency and accuracy of GHS functions, for assigned area(s). Serves as a resource, support and/or backup for others in department, as assigned or as determined by need. Oversees and assures that assigned function(s) operate(s) within budgetary constraints. Completes accurate and timely payables paperwork (may include both payments and receipts), following established procedures, for assigned area(s). Supervises departmental staff and processes and recommends changes as needed on a daily basis. Supervises operation of the staff daily and ensure all performance evaluations are timely.
4. Serves as resource and customer/employee relations representative for the System and oversees employee activities as necessary.
PERFORMANCE STANDARDS: Receives employee, manager and/or external requests for information and/or assistance in resolving issues, using proper telephone/customer service techniques. Provides information and/or resolves issues within scope of own knowledge and authority, within established timeframes, maintaining communication with customer throughout process. Forwards other requests/issues to appropriate person(s), maintaining ownership of issue until final resolution is obtained. Serves as employee/customer advocate to create, maintain and foster an environment that embodies GHS principles. Oversees and implements system-wide employee activities to promote good employee relations.
5. Responds to internal and external requests for information for assigned functions.
PERFORMANCE STANDARDS: Compiles and researches data and prepares recurring and ad-hoc reports with 100% accuracy. Provides accurate and timely information to external organizations and/or regulatory agencies, as assigned.
6. Performs all other duties as assigned.
EXPERIENCE REQUIREMENTS: 4-6 years progressive experience in Human Resources or related field.
EDUCATION REQUIREMENTS: Bachelors degree in Human Resources or related field desired or equivalent experience.
ADDITIONAL SKILL, LICENSE, AND/OR KNOWLEDGE REQUIREMENTS: Advanced proficiency in spreadsheet, word processing and database processing. Working knowledge of laws, regulations and practices related to assigned Human Resource functions, with thorough knowledge within specifically assigned area(s).
HIPAA REQUIREMENTS: Maintains knowledge of and adherence to all applicable HIPAA regulations appropriate to Job Position including but not limited to: employee health records, patients related complaints, employee prescriptions and employee PHI as related to Heath Plan and Employee Relations.
SAFETY REQUIREMENTS: Maintains knowledge of and adherence to all applicable safety practices appropriate to Job Position including but not limited to: incident reporting, exposure control plans, hand washing and environment of care.
Full-Time
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