Referral Processer

Job Requisition #: JR60555

End Date: 6/30/2022

Location: Wilmington, Delaware

Position Type: Clerical/Administrative/Billing, Clinical (non-nursing)

Shift: Day Shift, No Rotation

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Christiana Care is looking to hire a Referral Processor for a Primary Care office in Wilmington, DE.

As a referral processor you would be collaborating with physician/office to ensure a seamless delivery of services by facilitating the pre-authorization process for all testing to include high end imaging procedures.

PRIMARY FUNCTION:

Promotes physician and patient satisfaction by minimizing their involvement with 3rd party insurance providers for pre-authorizations. Communicates with provider of peer to peer review if required.  Collaborates with referring providers to obtain out-patient office referrals.

PRINCIPAL DUTIES AND RESPONSIBILITIES:   

  • Processing of referrals to ensure timely submissions to reduce delay of care for patients across WAM for 70+ physicians/residents/NPs
  • Ensure financial obligations for patient are handled prior to appointments
  • Verify insurance coverage and obtain authorization, as needed per insurance coverage
  • Gather pertinent information from insurance carriers and act as a liaison between hospitals, physicians, health plans, vendors, and patients or other referral sources
  • Provide support to clinical staff in order to facilitate the administrative components of clinical services for various services
  • Enters data into electronic system (PEAR) or other platforms internally and documents all communication, actions and other important information related to outcome of authorization requests for patients
  • Obtains pre-authorizations/referrals, in collaboration with the practice physician/provider, for procedures, medications, imaging studies: MRI, CT, etc.
  • Communicates patient demographic and clinical information to UM (Utilization Management) Companies (MedSolutions, AIM, and NIA) and/or 3rd party insurance providers, for referral and pre-certification requirements.
  • Performs daily operational duties such as insurance verification/pre-authorization, utilizing Powerchart, Soarian, Revenue Cycle and insurance web-site systems.
  • 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.
  • Superior performance in customer service and phone skills with the ability to handle difficult patient satisfaction issues and provide service recovery.
  • Demonstrates Christiana Care values and behaviors.
  • 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 AND EXPERIENCE REQUIREMENTS:

  • High School Diploma or equivalent required. Associate's degree preferred.
  • Two years experience in a medical practice with insurance processing knowledge preferred.
  • Directly related work experience may be substituted for educational requirements as determined by the practice.

KNOWLEDGE, SKILL, AND ABILITY REQUIREMENTS:

  • Exceptional organizational skills.
  • Knowledge of 3rd party billing practices.
  • Knowledge of CPT and ICD-10 coding.
  • Knowledge of computer equipment, capabilities, procedures and requirements.
  • Ability to coordinate work schedule to achieve maximum productivity and efficiency.
  • Ability to act and function independently and make accurate decisions without direct supervision.
  • Ability to maintain confidential information and materials.
  • Ability to establish and maintain superior quality customer service with patients, patient families, staff, visitors, insurance companies, physicians, physician office staff, and the general public.
  • Skill in providing exceptional customer service.
  • Skill in oral and written communication.

EEO Statement: Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.


UPDATE: ChristianaCare is committed to prioritizing the health and safety of our patients and caregivers. As we continue to meet the needs of our caregivers and our community through the COVID-19 pandemic, our commitment to health and safety requires that we take new steps to ensure a safe environment for medical care for our patients and a workplace that avoids preventable harm for our caregivers. For this reason, vaccination for COVID-19 is required for all caregivers at ChristianaCare and is considered a safety standard that is job-related and consistent with business necessity for all caregivers.

Why do WE offer careers full of possibilities?

For the Love of Health.

Inclusion & Diversity

At ChristianaCare, we’re committed to treating everyone with dignity and respect. We believe in a safe, inclusive work environment that fosters collaboration between caregivers from all walks of life. We know that each unique viewpoint is vital in delivering high-quality, safe patient care to everyone who walks through our doors. Our policies, benefits, hiring practices, employee resource groups, and corporate citizenship demonstrate our commitment to inclusion and diversity throughout our system.

Why do we embrace inclusion and diversity? For the Love of Health.

Our Values

We serve together in Love and Excellence. Our unique values, Love and Excellence are bold and powerful, and they are the reason why working for ChristianaCare is special. The behaviors associated with our values guide how caregivers interact with everyone they work with and make for an exceptional work experience. We believe that when you lead with Love, Excellence is inevitable.

Benefits

ChristianaCare’s comprehensive total rewards package is one of the most competitive in the region. We are proud to offer excellent benefits that reflect the organization’s commitment to being exceptional today and even better tomorrow.

At ChristianaCare, we provide access to high-quality and affordable benefits designed to meet our caregivers where they are. You can tailor your benefits to meet your needs now and adjust them as your priorities change.

Take advantage of ChristianaCare’s wide-ranging benefit offerings from supporting optimal health through medical, prescription, dental and vision coverage to valuable wellness and work/life programs, which include paid parental leave, coverage for infertility and assisted reproductive technologies, an employer-funded short-term disability program, and more.

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Our Region

A Great Place To Live

Our region offers a diversity of cultures, lifestyles, sports and entertainment events, housing options and educational opportunities. Located between Philadelphia and Washington, D.C., our locations provide easy access to two international airports, employment opportunities in a tri-state area, and proximity to some of the nation's top universities and colleges, as well as beaches in MD, DE and NJ!

Why Delaware? Why Maryland?
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We Serve Together

For the Love of Health

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