COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC continues to comply with governmental guidance related to local, state, and federal COVID-19 vaccination for employment. All employees and affiliated staff of UPMC entities are considered essential health care workers and will be accountable to follow the Centers for Medicare & Medicaid Services (CMS) federal vaccine mandate. To be compliant with the federal mandate, employees must complete the approved vaccination dosage regimen currently defined by the federal government. Compliance with the federal mandate is encouraged before hire and is required after employment begins. Medical and religious exemption requests may be submitted for consideration.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

Search Our Jobs

   Current UPMC employees must apply in HR Direct

Central Insurance Referral Spec. II

  • Job ID: 485734933
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: 9:00am - 5:30pm
  • Shift: Day Job
  • Facility: Pinnacle Health Medical Services - Admin
  • Department: Central Referral
  • Location: 3 Walnut Street, Lemoyne PA 17043
  • Union Position: No
  • Salary Range: $15.65 to $24.73 / hour

Description

Purpose:
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 patients 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:

 

  • Interacts with physicians, physician extenders, and all fellow employees in a courteous and professional manner.
  • Clearly explaining all policies and procedures, answering questions, and providing instruction to patients and family members in an age specific manner.
  • Being aware of the individual's needs, receptive to questions and criticism, and willing to offer assistance.
  • Protecting each person's legal and moral right to unbreached confidentiality.
  • Performs other duties as assigned by manager.
  • 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.
  • Answers telephone in a timely, pleasant, and professional manner.
  • 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.
  • Accurately schedules appointment with attention to all scheduling criteria.
  • Transcribes Epic orders as indicated by the ordering provider.
  • Handles Urgent and ASAP appointment requests in a timely fashion.
  • Maintains referral log.
  • Documents all referrals in patient medical record.
  • Maintains up-to-date listing of all network providers.
  • Completes insurance referrals for patients scheduled appointments.
  • Monitors referrals to ensure patients stay within network. If patient goes out of the network, coordinates with insurance to get patient back into network.
  • Coordinates appointments for diagnostic testing. Advises patient of test prep if applicable. Obtains insurance for authorization, if applicable.
  • Sends appointment request to specialist with appropriate patient records. Processes insurance referral if applicable.
  • Coordinates appointments with specialist's offices in and outside of the local area.
  • Attends meetings and training sessions provided by insurers.
  • Handles patient inquiries related to referrals and authorizations.
  • Maintains up to date referral and authorization guidelines and requirements from insurance companies.
  • Educates/assist providers on accurate diagnostic test order selection based on current radiology guidelines.
  • Educates members, providers, and office staff on the insurance guidelines and requirements, related to the referral and authorization process.

 

Qualifications

  • High school graduate or equivalent
  • Minimum of 3 years experience in a physicians 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.
  • Successfully completed the 6-month training in the Insurance Referral Specialist job and approved by Management to move into the Central Insurance Referral Specialist II position.
  • Prefer insurance referral, diagnotic authorizations experience


Licensure, Certifications, and Clearances:
New hire clearances must be dated within 90 days of hire
 

  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct