Position Summary: Arranges referral appointments for specialists utilizing managed care guidelines and practices. Maintains working knowledge of, and adheres to compliance with, Medicare, Medicaid, and managed care regulations.
Job Responsibilities: 1. Arranges referrals as indicated by the provider, utilizing proper insurance referral guidelines and CPT, ICD9 and HCPCS coding. May be required to send necessary lab and ancillary reports.
2. Verifies insurance information, current PCP, and medical necessity for the referral. Obtains authorization for release of medical records.
3. Obtains insurance pre-certification and authorization as required by the various insurance plans. Notifies the ordering provider of any conflict or delay in scheduling.
4. May schedule testing, make necessary appointments, document in the patient's chart and notify the patient of the appointment and necessary special instructions.
5. Pulls and retrieves files as required. Routes charts back to dictation area or file as indicated.
6. Answers telephones, routes messages and redirects as necessary.
7. Maintains referral log and verifies that patient completed appointment; verifies receipt of specialists consult notes and/or follows up with specialist if needed.
8. Follows the CHRISTUS Physician Group guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
9. Maintains strict confidentiality.
10. Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the CHRISTUS Mission.
11. Maintains established CHRISTUS Physician Group policies, procedures, objectives, quality assurance, safety, environmental and infection control.
12. Implements job responsibilities in a manner that is consistent with the CHRISTUS Mission and Code of Ethics and supportive of CHRISTUS Physician Group's cultural diversity objectives.
13. Supports and adheres to CPG Service Guarantee.
Our Mission: WHY WE EXIST. To extend the healing ministry of Jesus Christ. Our Core Values: WHAT WE BELIEVE IN.DIGNITY Respect for the worth of every person, recognition and commitment to the value of diverse individuals and perspectives, and special concern for the poor and underserved. INTEGRITY Honesty, justice, and consistency in all relationships. EXCELLENCE High standards of service and per...formance. COMPASSION Service in a spirit of empathy, love, and concern. STEWARDSHIP Wise and just use of talents and resources in a collaborative manner.Our Vision: WHAT WE ARE STRIVING TO DO. CHRISTUS HEALTH, a Catholic health ministry, will be a leader, a partner and an advocate in the creation of innovative health and wellness solutions that improve the lives of individuals and communities so that all may experience God's healing presence and love. Our Name and Symbol:WHO WE ARE. CHRISTUS is Latin for "Christ," and proclaims publicly the core of our mission. OUR NAME choice also recognizes the heritage of our two congregational sponsors, the Sisters of Charity of the Incarnate Word in Houston and San Antonio. Jesus Christ is the Incarnate Word, the Word of God made flesh. It is, therefore, only fitting that it is in another form of His name that our health ministries are called together. OUR SYMBOL Reflects the healing ministry of Jesus Christ - a combination of a medical cross and a religious cross. The flowing banner on the cross is a common symbol of the risen Christ, while the royal purple signifies Christ. The flowing banner also conveys a sense of motion as we move forward into a new era of service to our communities.