Citizens Medical Center is a not-for-profit hospital known for compassionate patient care, clinical expertise, and bringing advanced medical services to the South Texas region since 1956. Today, Citizens is a 338-bed acute care hospital with over 1,000 dedicated employees.
Citizens offers a generous benefit package that includes retirement plans upon hire, and an excellent medical plan with optional insurance plans to choose from.
If you are interested in pursuing a career with an award-winning hospital, welcome home.
Referral Specialist Gastroenterology/Urology - Days (PT)The Referral Specialist coordinates insurance referrals for Citizens Medical Professional patients, ensuring coverage meets the standards of order and referral criteria. The position provides insurance verification and authorization for insured patients. Uses phone and online resources and external phone inquiries regarding patient's benefits, procedures, and financial obligations as warranted. The Referral Specialist may also perform Patient Service Specialist responsibilities, including greeting patients, answering, and directing incoming phone calls, and checking patients in and out accurately and efficiently.
Job Specific: Responsible for oversight of the insurance referral/authorization process to include timely scheduling and complete processing of eligibility and benefit verification, initial and ongoing referral/authorization requests, and accurate entry of relation information in designated software system. (EF)Maintain policies and procedures to ensure timely communication of referral and authorization status to multiple locations as needed, providing necessary information to facilitate decision making for patient scheduling and visit utilization coverage. (EF)Maintains efficient tracking of all pending referrals to ensure timely scheduling and avoid loss of revenue. (EF)Performs routine review of outstanding requests and redirects workload as warranted.Accurately identifying required clinical information utilizing current procedural terminology (CPT) and International Classification Diseases and Health Care Procedure Coding System (ICD-10) to ensure minimal delay of authorization approval. (EF)Demonstrate ability to solve problems independently and perform at optimal level.Greets patients professionally and politely at check-in/check-out windows. (EF)Promptly answers and directs all incoming phone calls to the appropriate area professionally and politely by identifying our organization and self clearly and pleasantly. (EF)Checks patients in and out accurately and efficiently. (EF)Verifies all information to be complete and update as needed - makes changes as needed.Obtains insurance card and scans into EMR.Adds / updates financial group to correspond with payer type. (EF)Correctly enters insurance carrier into patient's demographics. (EF)Prepares charts for Out-of-Town Clinics as per clinic procedure. (EF)Prints Encounter tickets to nurses' printer. (EF)Confirms appointments and documents response in EMR. (EF)Logs echoes and holter from outside entities; delivers to physician for reading as per clinic procedure. (EF)Collects outstanding balances, co-pays and co-insurances due at time of check out. (EF)Reconciles cash drawer using designated format, and signs along with clinic manager.Hospital: Adheres to organization-wide and other applicable policies and procedures.Day-to-day performance complies with the hospital's Service Excellence Behavioral Expectations.Performs within the prescribed limits of the hospital's Ethics, Compliance and Confidentiality Program guidelines.Performs within professional Scope of Practice at all times.Other Duties As Assigned: Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
Required: One-year medical office pre-authorization and referral experience. Knowledge of payer guidelines and regulatory requirements, including third party procedures and practices required. Working knowledge of medical terminology, good human relations, and analytical skills required, ability to use computerized electronic medical record software.
Preferred: Two years medical office pre-authorization and referral experience.
SPECIAL SKILLS AND ABILITIES Required: Excellent communication, organizational and task prioritization skills.
Preferred: Excellent typing and computer skills, including work and excel. Ability to relate with people of diverse backgrounds, provide excellent customer service and solutions to issues. Understands Medical terminology, and knowledge of current procedure terminology (CPT), International Classification Diseases and Health Care Procedure Coding System (ICD-10), computer knowledge of Excel and Word.
COMPANY PROFILE Citizens Medical Center is a not-for-profit, community hospital known for compassionate patient care, clinical expertise, and bringing advanced medical services to the South Texas region since 1956. Today, Citizens is a 317-bed acute care hospital with over 1,200 employees. Voted "Best of the Best" hospital in Victoria for 14 consecutive years, Citizens Medical Center is a level III Trauma Center, with a newly renovated 24/7 Emergency Department that includes an onsite medical helicopter. Citizens has a comprehensive Community Cancer Program that includes two linear accelerators and HDR brachytherapy. Citizens is recognized for its outstanding cardiology program which includes a nationally accredited Chest Pain Center and is a Primary Stroke Center. Citizens also includes a comprehensive, accredited Bariatric Surgery program, Birth Center with labor and delivery, an imaging and surgery center, sleep study center, state-of-the-art rehabilitation and fitness center, urology center and daVinci robotics minimally invasive surgery options, a home health agency, and has a long history of providing continuing education for healthcare providers and the community.
Citizens Medical Center is looking for employees who actively demonstrate service excellence by exemplifying our iCare values. If you are someone who displays respect and enthusiasm for patients, visitors, and coworkers while consistently upholding the hospital's commitment to providing outstanding outcomes, service excellence, and fiscal responsibility, then you could be a good fit for the CMC team! BENEFIT OFFERINGS Health
STD, LTD DisabilitySupplemental Life, AD&DFlexible Spending (FSA)Employer paid life insurance and short term disabilityRetirement/Investment
457(b) Deferred CompensationPaid Time OffSick leave, Bereavement leave, Jury Duty/Witness ServiceTuition ReimbursementHospital-paid & administered annual immunizationsCitizens Medical Center is guided by its Mission – "to provide quality medical services at a reasonable cost to the citizens of the region."
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