Jobs
>
Presque Isle

    Referral Specialist - Presque Isle, United States - Northern Light Health

    Northern Light Health
    Northern Light Health Presque Isle, United States

    2 weeks ago

    Default job background
    Description
    Northern Light A.R. Gould


    Department:
    Physician Practice Central Ops


    Position is located:
    North Street Healthcare Mall


    Work Type:
    Part Time Eligible

    Hours Per Week: 20.00

    Work Schedule: 8:00 AM to 12:00 PM


    Summary:


    Referral specialists are responsible for assuring that patients needing diagnostic tests and specialty services are referred to the appropriate department/office efficiently to assure services needed are received timely.

    They assist with insurance prior authorizations.

    The role of the referral specialist is critical to assure that every patient receives the definitive care that they need.

    A major role of the Referral Specialist is to communicate progress of referrals to patients, families, and referring providers.

    Key characteristics to be successful include expert communication, knowledge of insurances and health systems, teamwork, collaboration, organizational skills, and detail orientation.

    Multitasking ability is essential as Referral Specialists often are working on multiple cases at a time. Fast paced setting requires independent thinking, ability and willingness to be flexible and adaptable to changes. Re-prioritization of tasks occurs frequently.


    Responsibilities:

    • Manages outgoing referrals and incoming referrals as assigned. 2. Obtains authorizations for procedures and diagnostics as assigned. 3. Communicates with patients, providers, office staff, insurers and referrers. Works collaboratively with clinical staff, providers, surgical schedulers, ancillary departments, and insurance carriers to complete work 4. Adds new patients to EMR when needed, including assisting with scheduling as assigned. 5. Manages and monitors prior authorizations/out-going referrals for the assigned departments(s) following AR Gould Policy and Procedures. 6. Maintains working knowledge of inpatient vs. outpatient procedures and CPT codes. 7. Maintains referral tracking documentation to determine that referral is complete. 8. Maintains current knowledge of various insurance processes necessary to obtain prior authorization; follows Prior Authorization Policy. 9. Assists with claim denials/research as assigned. 10. Assists with coding to assure appropriate authorization of procedures. 11. Makes recommendations for change to improve processes in accordance with AR Gould mission statement and established goals. 12. Ensures compliance with Medicare and third-party payers' procedures. 13. Maintain safety standards at all times and report safety issues immediately 14. Maintains mandatory education compliance.

    Other Information:
    Competencies and Skills


    • Behaves with Integrity and

    Builds Trust:
    Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.

    • Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
    • Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
    • Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
    • Exercises Sound Judgment &

    Decision Making:
    Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.

    • Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
    • No previous experience required.
    • Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
    Education


    • Required Associate's Degree: Associate degree in business management, healthcare, administration, medical coding, or related field or 2 years' experience in a medical office or related setting is required.
    Working Conditions


    • Prolonged periods of sitting.
    • Lifting, moving and loading less than 20 pounds.

  • Northern Light Health

    Referral Specialist

    2 weeks ago


    Northern Light Health Presque Isle, United States

    Northern Light A.R. Gould · Department: Physician Practice Central Ops · Position is located:North Street Healthcare Mall · Work Type: Full Time · Hours Per Week: 40.00 · Work Schedule: 8:00 AM to 4:30 PM · Summary: · Referral specialists are responsible for assuring that patien ...

  • Northern Light Health

    Referral Specialist

    2 weeks ago


    Northern Light Health Presque Isle, United States

    Northern Light A.R. Gould · Department: Physician Practice Central Ops · Position is located: North Street Healthcare Mall · Work Type: Part Time Eligible · Hours Per Week: 20.00 · Work Schedule: 8:00 AM to 12:00 PM · Summary: · Referral specialists are responsible for assuring ...


  • LanceSoft Presque Isle, ME, United States

    LanceSoft is seeking a travel Physical Therapist for a travel job in Presque Isle, Maine. · Job Description & Requirements · Specialty: Physical Therapist · Discipline: Therapy · Start Date: 06/10/2024 · Duration: 13 weeks · 40 hours per week · Shift: 8 hours, days · Employment T ...


  • LanceSoft Presque Isle, ME, United States

    LanceSoft is seeking a travel Physical Therapist for a travel job in Presque Isle, Maine. · Job Description & Requirements · Specialty: Physical Therapist · Discipline: Therapy · Start Date: 07/01/2024 · Duration: 13 weeks · 40 hours per week · Shift: 8 hours, days · Employment T ...


  • OneStaff Medical Presque Isle, ME, United States

    OneStaff Medical is seeking a travel Nuclear Medicine Technologist for a travel job in Presque Isle, Maine. · Job Description & Requirements · Specialty: Nuclear Medicine Technologist · Discipline: Allied Health Professional · Start Date: ASAP · Duration: 13 weeks · 40 hours per ...

  • OneStaff Medical

    Travel Nurse RN

    2 days ago


    OneStaff Medical Presque Isle, ME, United States

    OneStaff Medical is seeking a travel nurse RN OR - Operating Room for a travel nursing job in Presque Isle, Maine. · Job Description & Requirements · Specialty: OR - Operating Room · Discipline: RN · Start Date: ASAP · Duration: 13 weeks · 40 hours per week · Shift: 9 hours, days ...

  • Archway Physician Recruitment

    Psychiatry Child

    3 weeks ago


    Archway Physician Recruitment Presque Isle, ME, United States Full time

    Psychiatry Opening in Presque Isle, ME Bangor 158mSeeking a full-time, BE/BC Psychiatrist to help lead our outpatient practices in beautiful Presque Isle, Maine. Located within our Primary Care facility in Presque Isle, the practice has access to a child psychiatrist, an infectio ...

  • Alliance Health Staffing

    Surgeon - health

    3 weeks ago


    Alliance Health Staffing Caribou, ME, United States

    Location: Caribou · Specialty Needed: Orthopedic Surgeon · BC/BE Requirements: Certification or Eligibility Required · Length Of Assignment: Permanent Position · Facility Type: Hospital · Call Requirements: 1:3 · Unlimited potential exists for full time Orthopedic Surgeons t ...


  • AB Staffing Caribou, United States

    Medical Technologist - Caribou, ME 04736 Are you ready to explore new places while building your resume? At AB Staffing, we specialize in placing Allied Health providers in facilities throughout the United States. Our travel assignments range from three (3) months to one year, an ...


  • Cary Medical Center Caribou, United States

    Status Hours: 40hr/wk · Cary Medical Center has an exciting opportunity for a Prior Authorization Specialist to join our team. The successful applicant will obtain pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient tes ...


  • Cary Medical Center Caribou, United States

    Job Type · Full-time · Description · Status Hours: 40hr/wk · Cary Medical Center has an exciting opportunity for a Prior Authorization Specialist to join our team. The successful applicant will obtain pre-certifications and pre-authorizations for procedures and medications, sc ...


  • State of Maine Caribou, United States

    Department of Health and Human Services (DHHS) · Opening Date: May 10, 2024 · Closing Date: May 24, 2024 · Job Class Code: 5073 · Grade: 19 (Professional & Technical Services) · Salary: $21.97 -$25.66/hourly* · *Employees in this classification begin at Step 4 of the pay sc ...


  • Continuum Physician Recruiting Caribou, ME, United States

    These opportunities have come about due to the expansion of our services to the community and the Medical Center. The communities we serve are economically, culturally, and socially inviting. · As an employee, the successful Orthopedic Surgery candidate will receive a competitiv ...


  • Continuum Medical Staffing Caribou, ME, United States

    Unlimited potential exists for Orthopedic Surgeons to join our practice. These opportunities have come about due to the expansion of our services to the community and the Medical Center. The communities we serve are economically, culturally, and socially inviting. · As an employ ...


  • Continuum Physician Recruiting Caribou, ME, United States

    Unlimited potential exists for Orthopedic Surgeons to join our practice. These opportunities have come about due to the expansion of our services to the community and the Medical Center. The communities we serve are economically, culturally, and socially inviting. · As an employ ...