At Lancaster General Health, our culture is what sets us apart and creates a lasting impression of our health system in the community and in the hearts of our patients and their families. A role with us is more than just a job. We ask that you Live Your Legacy by finding your passion in your everyday role, committing to those you serve, and reaching for your personal best.
We are recognized as 1 of only 9 hospitals in the entire country with awards in Medicare.Gov, LEAPFROG and Healthgrades Americas 50 Best Hospitals. We have achieved four-years of Magnet ® status with the American Nurses’ Credentialing Center (ANCC) and we are the 2018 recipient of the Foster G. McGaw Prize in recognition of the commitment to community service.
Join us and be part of a team that empowers you to do more than your job and encourages you to:
Live Your Passion. Live Your Best. Live Your Commitment. Live Your Legacy.
Lancaster General Medical Grp
61026 Referral Office - West
Authorizations & Financial Clearance
ATTENTION: Please be aware that, if you are an external applicant, you may need to complete an online assessment as part of the hiring process. This assessment will be sent to the e-mail address that you included in your application. Please note: Some e-mail accounts may receive the assessment e-mail in their junk/spam e-mail. This assessment must be completed within 5 days of receiving it. For more information regarding the assessment, please click HERE.
POSITION SUMMARY: Plans, organizes, directs and coordinates all aspects of the referral office.
This position is 40hrs/week, between the hours of 8am-5pm.
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.
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
- 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
ATTENTION/CONCENTRATION – The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others:
- The position requires the ability to attend to more than one aspect of a situation simultaneously. It is highly likely that multiple task demands are going to be required of the individual at the same time.
NEW LEARNING AND MEMORY – The following level of ability is essential for the jobholder to learn and retain material:
- The position requires that an individual be able to learn new tasks quickly and effectively. Job requirements change frequently. The ability to understand and carry out detailed, involved instructions in mandatory.
PROBLEM SOLVING, REASONING AND CREATIVE THINKING – The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought:
- The position deals with issues or problems that often require thoughtful reasoning before arriving at approaches or solutions. Some independent thought, planning or origination of options and solutions is necessary. The individual must have the ability to apply principles of reasoning and problem solving to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
APTITUDES: The following are essential requirements of the position in relation to job-worker situations. These items describe how a worker must adapt, adjust, conform or act:
Leadership, control and planning: Ability to accept responsibility for leadership, direction, control, planning, negotiating, organizing, directing, supervising, formulating practices, or making final decisions.
Repetitive work: Ability to continuously perform the same type of work for extended periods of time, according to set procedures, sequence or pace.
Performing under stressful conditions: Ability to perform under stress when confronted with emergency, critical, unusual, or dangerous situations, or in situations in which working speed and sustained attention are critical aspects of the job. Is subject to danger or risk, or to tension as a regular, consistent part of the job.
Variety and change: Ability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure involving significant differences in technologies, techniques, procedures, environmental factors, physical demands, or work situations.
Communication: Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.
Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.
EQUIPMENT USAGE REQUIREMENTS
Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office Supplies
Software: Microsoft Office Products, RAS, SMS, EPIC, Sovera, Web Access for validation of eligibility, and other electronic insurance verification tools.
Rarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%
- Sit: Frequently
- Stand: Frequently
- Walk: Frequently
- Bend: Rarely
- Push: Rarely
- Pull: Rarely
- Kneel/Squat: Rarely
- Reach: Occasionally
- Twist: Rarely
- Balance: Rarely
- Climb: Rarely
Lifting: Degree of physical exertion is:
Light, exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to move objects.
Sensory Abilities specifically required:
WORKING CONDITIONS: Exposure to hazardous conditions/ materials is negligible.
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.
Lancaster General Health invests in the Employee Total Rewards by providing our employees with a competitive comprehensive packaging inclusive of:
Generous paid time off, Health, Dental, Vision, Wellness and Prescription, Retirement with an employer match and basic contribution, Tuition discounts and a tuition free affiliation with Pennsylvania Health Sciences. We also provide subsidized childcare, life insurance and career advancement opportunities for long term career growth.
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.
Posted on 08/27/2020