"Alerted.org

Primary City/State:

Scottsdale, Arizona

Department Name:

BUMCP Cardiovascular

Work Shift:

Day

Job Category:

Administrative Services

Health care is constantly changing, and at Banner Health, we are at the front of that change. We are leading health care to make the experience the best it can be. We want to change the lives of those in our care – and the people who choose to take on this challenge. If changing health care for the better sounds like something you want to be part of, we want to hear from you.

The Referral Specialist role is specialized in the sense that you will be: Ensuring referrals are addressed in a timely manner; Verifies and updates patient registration information in the system/chart. Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all specialty consultations and follow ups; Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility; attaches referrals and authorizations to patients’ chart for billing purposes and assist with phones as needed.

This position will support our **new** Scottsdale Cardiology practice opening in October 2025.

_**Training and work prior to opening will be at our_ _Banner University Medicine Heart Institute_ _755 E McDowell Rd Floor 4, Phoenix, AZ 85006**_

**Hours/Schedule:** Mon-Fri 8:00AM-5:00PM (No weekends or Holidays!)

Banner University Medical Group is our nonprofit faculty practice plan associated with the University of Arizona Colleges of Medicine in Phoenix and Tucson. Our 800-plus clinicians provide primary and specialty care to patients at highly ranked Banner - University Medical Centers and dozens of clinics while providing mentorship to more than 700 residents and fellows. Our practice values and encourages the three-part mission of academic medicine: research, education and excellent patient care.

POSITION SUMMARY

This position is responsible for coordinating referral orders for a continuation of treatment, such as specialty services and diagnostic testing within a primary care practice. This position provides all pertinent clinical information needed for the payor authorization and the facility or specialist prior to the services being rendered. The position is responsible for tracking and managing all referrals with the intention and outcome to close any patient care gaps, along with providing documentation to promote team awareness.

CORE FUNCTIONS

1. Schedules appointments for specialty physician services and diagnostic testing per provider request and communicates with the patient on a timely basis for all scheduling requirements

2. Acts as a liaison between patients, providers and staff members for patients’ referral and follow up needs. Provides prompt and professional service for the patients by assisting in educating patient/family and assisting patients with external resources when needed.

3. Provides all pertinent clinical information needed for the payor authorization, the facility or specialist prior to the services being rendered by verifying coverage, obtaining authorization and communicating with receiving facilities

4. Tracks and manages all referrals by monitoring outstanding referrals at 30/60/90 day intervals and following up with patients if appointments are not kept

5. Applies knowledge of medical terminology and maintains up to date knowledge of insurance environment. Utilizes internal and external resources to seek knowledge about regulations regarding various payor sources

6. Collaborates with outside referral sources and other community resources. Maintains an updated list of community resources and networks with colleagues to develop additional referral sources

7. This position has frequent communications with patients, physicians, staff, and third party payers. The position must work with and understand the concepts of managed health care and be able to prioritize tasks within established guidelines with moderate supervision

MINIMUM QUALIFICATIONS

High school diploma/GED or equivalent working knowledge.

Possesses 1 year of direct patient interaction/experience in a medical, insurance, or healthcare related industry.

Knowledge of HIPAA regulations. Strong customer service focus and willingness to problem solve. Effective verbal and written communication skills and the ability to manage competing priorities. Must be proficient with commonly used office software.

Employees working at Banner Scottsdale Sports Medicine, second floor must possess an Arizona Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment.

PREFERRED QUALIFICATIONS

Previous knowledge of managed care concepts. Working knowledge of medical terminology and ICD-9 and CPT codes.

Additional related education and/or experience preferred.

EEO Statement:

EEO/Disabled/Veterans (https://www.bannerhealth.com/careers/eeo)

Our organization supports a drug-free work environment.

Privacy Policy:

Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy)

EOE/Female/Minority/Disability/Veterans

Banner Health supports a drug-free work environment.

Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability