Job Details
ChristianaCare Primary Care is looking for a Referral Processor.
This position will be supporting Primary Care practices, based off of volume and service levels. This position will be located at Avenue North. The Contact Center at Avenue North is located at 4000 Nexus Drive in Wilmington, Delaware. Located just north of the City of Wilmington and five minutes from I-95, Avenue North is situated in a premier location attracting various tenants ranging from cutting edge corporations to exquisite restaurateurs to young professionals and empty-nesters alike.
Avenue North - Live Connected to Everything (avenuenorthde.com)
You will be collaborating with the providers and office to ensure a seamless delivery of services by facilitating the pre-authorization process for all testing to include high end Imaging procedures (i.e., MRI, CT, PET, etc.) and medications. You will help promote provider and patient satisfaction by minimizing their involvement with 3rd party insurance providers for pre-authorizations. You will communicate effectively with each provider of peer-to-peer review, if required. You will collaborate with referring providers to obtain out-patient office referrals.
Work Schedule:
- Monday through Friday from 8am to 4:30pm
Compensation / Benefits:
- Full Medical, Dental, Vision, Life Insurance, etc.
- Two retirement planning offerings, including 403(b) with company contributions.
- Generous paid time off with annual roll-over and opportunities to cash out.
- 12 weeks paid parental leave.
- Tuition assistance
- Incredible Work/Life benefits including annual membership to care.com, access to backup care services for dependents through Care@Work, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets, insurance and much more!
Job duties & responsibilities:
- Processing of referrals to ensure timely submissions to reduce delay of care for patients across Wilmington Health Center (Wilmington Adult Medicine and Wilmington Pediatrics) for 70+ physicians/residents/NPs.
- Performs daily operational duties such as insurance verification/pre-authorization, utilizing Powerchart, Soarian, Revenue Cycle.
- Act as a liaison between hospitals, physicians, health plans, vendors, and patients or other referral sources
- Communicates patient demographic and clinical information to UM (Utilization Management) Companies (Med Solutions, Pear, AIM, and NIA) and/or 3rd party insurance providers, for referral and pre-certification requirements.
- Maintains a solid working knowledge of insurance and billing requirements related to imaging procedures and out-patient office visits for maximum reimbursement of claims and to minimize financial risks.
- Respond/document in a timely manner to all messages in the Referral and Authorization Pools. Escalating issues or concerns to Site Manager when appropriate.
- Performs assigned work safely, adhering to established departmental safety rules and practices. Reports to the appropriate personnel, in a timely manner, any unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, patients and visitors.
- Demonstrates compliance with Christiana Care and departmental policies and procedures and mandatory education requirements including but not limited to safety, infection prevention, attendance and dress code.
- Performs other related duties as required.
Education Requirements:
- High School Graduate or Equivalent Required. Associate degree is preferred.
- 2 years' experience in a medical practice with insurance processing knowledge required.
- Directly related work experience may be substituted for educational requirements as determined by the practice.
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