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Our Central Referral team is looking for a Central Insurance Referral Specialist to join their fast-paced team in the Lancaster area!

The ideal candidate is able to work between 8:30am - 5:00pm and has prior expereince with insurance referrals, verification and authorizations. If interested in learning more about this exciting opportunity, apply today!

Purpose:

The Central Insurance Referral Specialist II will be responsible for coordination of the referral process within the outpatient sites. Responsible for coordinating specialty referrals and diagnostic testing for outpatient facilities. Pre-certifies diagnostic testing, as required by patient's insurance. Educates the patients on various policies, procedures, and benefits, related to the need for referrals. Coordinates referrals with patients and specialist's offices, and process insurance referrals as required. Acts as a liaison between patient, physician, and insurance company, consistently performing activities in a friendly, courteous, and professional manner. The Insurance Specialist II will be responsible to process referral/authorizations for greater than 3 specialties and multiple geographical locations.

Responsibilities:

+ Utilizes electronic referral and authorization services as available.

+ Communicates with insurance offices to authorize services.

+ Takes referral requests from patient, specialist, and primary care office.

+ Handles appeal requests with insurance company when necessary.

+ Coordinates out of network exceptions with insurance company when necessary.

+ Provides necessary patient medical information to insurance upon request.

+ Obtains authorizations with insurance companies for diagnostic testing.

+ Transcribes Epic orders as indicated by the ordering provider.

+ Documents all referrals in patient medical record.

+ High school graduate or equivalent

+ Minimum of 1 year experience in a physician's office or outpatient facility.

+ Knowledge of Electronic Medical Records/Electronic Health Information systems.

+ Knowledge of insurance companies, guidelines and requirements, authorization and referral process and websites.

+ Knowledge of medical terminology, anatomy, disease processes, CPT and ICD-9 coding, and managed care policies and procedures.

+ Familiar with Windows software, Word and Excel and Outlook.

+ Must possess strong organization and communication skills and be able to work independently and within a team.

Licensure, Certifications, and Clearances:

+ Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran