Job DescriptionLocated in Kailua, Adventist Health Castle has been one of the area's leading healthcare providers since 1963. We are comprised of a 160-bed hospital, eight medical offices, home care services, urgent cares and a vast scope of services located throughout O'ahu. In 2017, Adventist Health Castle was recognized with the Malcolm Baldrige National Quality Award, the nation's highest presidential honor for performance excellence. O'ahu is known for its ideal climate, diverse culture and picturesque landscape. The allure of Castle's laid-back lifestyle is complimented by its close-knit and proud community.Job Summary:Manages incoming and outgoing referrals from Imaging, primary and specialty providers in a timely and professional manner; schedules appointments according to practice policy; maintains positive relations with referral sources; schedules appointments from third party electronic referral systems, fax, email and web requests; and participates in marketing to referring practices. Provides quality customer service & patient financial responsibilities to patients, referring physicians, visitors and internal customers by obtaining insurance authorization and benefit verification for imaging procedures and specialty referrals.Job Requirements:Education and Work Experience:
- High School Education/GED or equivalent: Preferred
- Associate's/Technical Degree or equivalent combination of education/related experience: Preferred
Essential Functions:
- Processes inbound and outbound referrals, verifies referrals are correctly ordered according to protocols in the EHR. Obtains benefit verification and necessary authorizations (referrals, pre-certification) prior to patient arrival for all ambulatory visits, procedures, injections and radiology services.
- Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility. Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
- Serves as navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns. Occasionally assumes advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion. Assists patient in problem-solving potential issues related to the healthcare system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance)
- Maintains satisfactory productivity rates and ensures the timeliness of referral and scheduling while maintaining work queue goals.
- Collaborates effectively with Care Connection Center associates and responds to provider (internal and external) and support staff questions, requests and concerns regarding the status of patient referrals, care coordination or follow-up status.
- Performs other job-related duties as assigned.
Organizational Requirements: Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.About UsLocated in Kailua, Adventist Health Castle has been one of the area's leading healthcare providers since 1963. We are comprised of a 160-bed hospital, eight medical offices, home care services, urgent cares and a vast scope of services located throughout O'ahu. In 2017, Adventist Health Castle was recognized with the Malcolm Baldrige National Quality Award, the nation's highest presidential honor for performance excellence. O'ahu is known for its ideal climate, diverse culture and picturesque landscape. The allure of Castle's laid-back lifestyle is complimented by its close-knit and proud community.