Summary

Job Description

POSITION SUMMARY: Plans, organizes, directs and coordinates all aspects of the referral office.

HOURS: M-F 8:30AM-5PM day shift, no weekends or holidays currently *occasionally asked to stay after 5:00pm

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

• Coordinates and monitors daily work flow processes and activities for meeting required referral/insurance deadlines (within 72 hours/or as directed by provider – e.g., Stat/emergent).

• Daily reviews and monitors referral work que in order to provide accurate and timely referral process documentation.

• Serves as the first-line resource for all customers (internal/external) with regards to Insurance and Referrals. Must be knowledgeable in all areas of insurance verification and authorization/referral processes.

• Maintain accurate and current referral log on all patients.

• Serve as liaison for patient with doctor offices with regards to processing referrals. Communication may be via fax/telephone/electronically.

• Review and analyze managed care patient visits and ensure proper documentation of required services.

• Coordinate internal functions and recordkeeping related to managed care organizations to meet compliance.

• In collaboration with staff in LG Patient Financial Services, ascertain physician credentialing is current and required documentation on file.

• Organizes in-service programs for staff regarding all referral/insurance process changes and updates.

• Liaison between patient and insurance company to explain to patient what their insurance company requires to meet referral/authorization compliance.

• Must have the ability to communicate in a positive, customer service manner when communicating with all customers or when using Department tools (i.e., telephone, fax, email, voice mail, etc.).

• Exhibits teamwork and excellent customer service skills without exception, at all time for both internal and external customers.

• Collaboratively works with internal/external LG staff, other physician offices, and outside agencies, to resolve patient questions and complaints regarding referral/insurance issues.

SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:

• Maintains knowledge of registration and scheduling processes with the capability of filling in as needed based on office workload or staffing demands.

• As needed, assist Billing Coordinator with assigned tasks.

• Provide educational sessions to resident physicians and staff.

• Identifies any system dysfunction or discrepancies and reports to Supervisor/Manager, making recommendations for improving current department and hospital-wide procedures.

• Assist with other projects or responsibilities as required by Supervisor/Manager.

• Addresses gaps in care in an attempt to help patients reconcile any remaining health care screenings or surveillances.

• May outreach to patients who expresses a desire for a new LGHP PCP to schedule an appointment. Outreaches to patients who have not been seen within the prior 18 months at their LGHP PCP office and schedules patients accordingly to maintain their LGHP relationship.

• Other duties as assigned.

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:

• High school diploma or certificate

• One (1) year of computer experience

• One (1) year clerical or clinical experience in a medical practice setting

• One (1) year experience in medical referral/insurance

PREFERRED QUALIFICATIONS:

• One (1) year of using medical terminology

• Basic keyboarding ability and telephone/interpersonal etiquette is required. Successful completion of customer service training module or commensurate experience with successful completion of related competency testing is also required

Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards. The percentages of time spent performing job duties are estimates, and should not be considered absolute. The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole. Incumbent must be able to perform all job functions safely.

Benefits At A Glance:

PENN MEDICINE LANCASTER GENERAL HEALTH offers the following benefits to employees:

• 100% Tuition Assistance at The Pennsylvania College of Health Sciences

• Paid Time Off and Paid Holidays

• Shift, Weekend and On-Call Differentials

• Health, Dental and Vision Coverage

• Short-Term and Long-Term Disability

• Retirement Savings Account with Company Matching

• Child Care Subsidies

• Onsite Gym and Fitness Classes

Disclaimer

PENN MEDICINE LANCASTER GENERAL HEALTH is an Equal Opportunity Employer, committed to hiring a diverse workforce. All openings will be filled based on qualifications without regard to race, color, sex, sexual orientation, gender identity, national origin, marital status, veteran status, disability, age, religion or any other classification protected by law.

Search Firm Representatives please read carefully: PENN MEDICINE LANCASTER GENERAL HEALTH is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, all resumes submitted by search firms to any employee at PENN MEDICINE LANCASTER GENERAL HEALTH via-email, the Internet or directly to hiring managers at Penn Medicine Lancaster General Health in any form without a valid written search agreement in place for that position will be deemed the sole property of PENN MEDICINE LANCASTER GENERAL HEALTH, and no fee will be paid in the event the candidate is hired by PENN MEDICINE LANCASTER GENERAL HEALTH as a result of the referral or through other means.

PENN MEDICINE LANCASTER GENERAL HEALTH, a member of the University of Pennsylvania Health System (Penn Medicine), is a not-for-profit health system with a comprehensive network of care encompassing Lancaster General Hospital (LGH), Women & Babies Hospital and the Lancaster Rehabilitation Hospital (a partnership with Kindred Healthcare). We are an Accredited Trauma Center-Level I through the Pennsylvania Trauma Systems Foundation with 805 Licensed beds. Our membership in Penn Medicine brings together the strengths of a world-renowned, not-for-profit academic medical center and a nationally recognized, not-for-profit community healthcare system.

Outpatient services are provided at the Downtown Outpatient and Suburban Outpatient Pavilions, along with additional outpatient centers and Express and Urgent Care locations throughout the region. Lancaster General Health Physicians is a network of more than 300 primary-care and specialty physicians, at more than 40 offices throughout the region.