Boulder Community Hospital
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Referral & Insurance Specialist
at Boulder Community Hospital
Work Hours: M-F, 8-5
This position will be involved in the central processing of prior-authorizations and referrals for multiple primary care practices. This position is responsible for ensuring that patients receive pre-authorizations in a timely manner from insurance carriers for testing and/or medications. Also responsible for insuring that patients have been cleared for specialty service office visits prior to their appointment. This will require follow-up and communication back to the patient’s primary care practice as well as frequent communication with health insurance companies.
Education or Formal Training
1. High school graduate or GED preferred.
Special Qualifications (Licensure, Registration, etc.)
Knowledge, Skill and Ability
1. Knowledge of medical terminology and general knowledge of medical procedures.
2. Knowledge of health insurance.
3. Knowledge of organizational policies, procedures, and systems to perform job duties.
4. Familiar with JCAHO, OSHA, and Corporate Compliance Program.
5. Skill in telephone communication and etiquette.
6. Skill in working effectively with patients and their representatives, managers, staff, physicians, other hospital departments, outside agencies, and the public.
7. Ability to comprehend and follow both oral and written instructions.
8. Ability to communicate clearly and concisely.
9. Ability to operate telephone, photocopies, fax machine, and other such office equipment.
10. Ability to follow through with attention to detail.
11. Ability to apply written guidelines and procedures to standard work practices.
2. Experience with medical terminology preferred.
3. Previous referral experience preferred with knowledge of health insurance.
MATERIALS AND EQUIPMENT DIRECTLY USED
WORKING ENVIRONMENT/PHYSICAL ACTIVITIES
1. Medical office environment.
2. Requires sitting for extended periods of time, as well as some stooping, bending, and stretching.
3. Occasionally involves lifting files or paper weighing up to 30 pounds.
4. Requires manual dexterity sufficient to operate keyboard, telephone, copier, and other such equipment as
5. Requires normal range of vision and hearing.
1. Consistent and on time attendance is an essential function of the position.
2. Acquires authorization for referral from appropriate insurance carrier in a timely manner.
3. Communicates with patients and physicians regarding referral information.
4. Follows up with insurance carrier when referrals are denied in a timely manner.
5. Documents appropriate information in patient charts, as well as in logbook for future reference.
6. Maintains strict patient confidentiality.
7. Upholds guidelines set forth in department/clinic/organization.
8. Attends meetings and participates on committees as required.
9. Maintains neat and professional appearance.
10. Demonstrates commitment and dependability.
11. Meets standards of professional appearance.
12. Establishes and maintains effective, professional working relationships with patients and their representatives, managers, staff, physician, other hospital departments, outside agencies, and the public.
13. Embraces and upholds philosophy of patient service and satisfaction.
14. Effectively interacts with and/or provides service for patient service and satisfaction.
15. Effectively interacts with and/or provides service for patients ages newborn to geriatric.
16. Employees are expected to comply with all regulatory requirements, including Joint Commission Standards.
17. Is familiar with organization, department and job specific Environment of Care areas, including Life Safety, Utilities Management, Hazardous Materials Communications, Emergency Preparedness, Infection Control and Medical Equipment Failure.
18. Adheres to Standard Precautions as appropriate, which may include:
a. the use of protective barriers, as appropriate (e.g., gloves, masks, gowns, pocket masks, and/or safety glasses);
b. handling and disposing of infectious waste appropriately; and
c. hand washing as appropriate.
OTHER DUTIES AND RESPONSIBILITIES
1. Acts as back-up for front desk as needed.
2. Acts as phone receptionist as needed.
3. Files, locates EOB’s, mails HCFA’s.
4. Performs related duties as assigned.