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Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for the day to day operations of the Referral Center. Manages and integrates the activities of the specialty and radiology referrals, insurance verification and pre registration functions to provide timely and accurate scheduled appointments. Provides effective leadership by coordinating operations within the department including Leaders of Referral Specialists, Scheduling and Pre Registration and with other clinical and non-clinical departments to support the patient experience.
Essential Functions
Responsible for the authorization/precertification to include coordinating with internal and external organizations along with insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis and prognosis. Provides specific medical information to financial services to maximize reimbursement to the hospital and physicians. Verifies and updates patient insurance eligibility, benefits and demographics. Responsible for obtaining quality data for hospital billing and for the collection of Point of Scheduling deposits. Manages department human resources by implementing and monitoring staffing plans, providing orientation, in-service training and continuing education. Manages information by providing data management for operations and performance improvement. Serves as co-administrator and super-user of multiple clinical documentation systems. Serves as department liaison between the department and IT regarding varied systems utilized by Referral Specialist and Schedulers to ensure optimum efficiency and effectiveness of key tools. (STAR, Epicenter, Horizon, MedAssets). Manage information by providing information systems and data management for department operations and performance improvement. Continuously assess and improve the department's performance by designing operational processes, monitoring performance through data, analyzing the data, implementing sustainable performance improvement, and participating in multi-disciplinary inter-departmental activities. Monitors quality assurance process in the department to ensure accurate and timely submission of clinical information and insurance verification to determine training needs. Performs other duties as assigned.
Supervisory/Management Responsibilities
Job has direct and/or indirect supervision of employees that may include final budget authority, hire/termination/disciplinary authority, performance appraisal responsibility. Job will be considered a member of the management staff with direct reports.
Minimum Requirements
Education - Bachelor's degree Experience - 5 years - Experience in hospital. Must have experience with electronic medical record review. Previous experience required in one of the following areas: pre-certification, authorization, insurance verification, referrals or a related field. At least 2 years leadership experience preferred.
In Lieu Of
Required Certifications, Registrations, Licenses
Knowledge, Skills and Abilities
Excellent communication skills, written and oral, including the ability to communicate and collaborate with physicians, departments and other PH leaders as well as negotiate resolution with third party payor auditors and management. Ability to think analytically, independently, and objectively. Ability to use Microsoft Word and Excel proficiently. Work Shift Day (United States of America)
Location Colonial Life Building
Facility 7001 Corporate
Department 70019073 PreAccess Services
Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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Prisma Health
Apr 07, 2025