Referral Specialist

The Referral Specialist is an integral part of the clinic team. Responsibilities include coordinating referral processes for the assigned area of service(s) or provider(s) by preparing referrals and obtaining authorizations and pre-certifications.  The Referral Specialist also verifies patient’s benefits and eligibility and may assist patient in obtaining proper paperwork for claims.   

Duties and Responsibilities

The Referral Specialist performs the following duties as assigned.

1. Provides clerical services.
   1. Coordinates and facilitates referrals according to the process as defined in Referral Specialist training.
   2. Ensures patients have been cleared for specialty services, as required by provider/insurance.
   3. Resolves pre-certification, registration and case-related concerns prior to a patient’s appointment.  
   4. Gathers pertinent information from insurance carriers, financial counselors, and other staff to make certain the patient's financial obligations for services provided. 
   5. Follows up with patient to confirm appointment; reschedules if necessary
   6. Provides support to clinical staff in order to facilitate the administrative components of clinical referrals for various services. 
   7. Acts as a liaison between hospitals, physicians, health plans, vendors, and patients, or other referral sources. 
   8. Verifies insurance coverage and obtains authorizations if needed from insurance coverage. 
   9. Accurately enters referrals and documents communications, actions, and other data in an information system. 
   10. Reports issues, non-compliance or patient no shows to Practice Manager, Supervisor (Coordinator) or Provider
   11. Answers telephone lines promptly, greets appropriately.
   12. Handles inquiries when able and/or refers them to appropriate personnel.
   13. Secures all necessary signatures to facilitate referral.
   14. Various secretarial duties. 
   15. Verifies insurance benefits and obtains necessary information needed.  

1. Demonstrates strong initiative to get daily work finished and processed.
2. Communicates effectively with patients, physicians, providers and others. 
3. Demonstrates accurate judgment.
4. Notify supervisor of any problems, in a timely manner and works to resolve said issues.

1. Fulfills administrative duties.
   1. Assists in maintaining an efficient, safe, secure, orderly, and aseptic environment of care for all patients and employees.
   2. Is familiar with and abides by OSHA Standards, Hazardous Materials, Universal Precautions, use of personal protective equipment, Evacuation, Fire, Disaster, and Safety Plans.
   3. If bilingual, translates in Spanish between non-Spanish speaking staff and Spanish speaking patients as requested.
2. Performs all other duties as assigned.

Knowledge, Skills and Abilities

Required

• Knowledge of protocols in general and an ability to quickly gain specific knowledge of the Clinic’s current operational protocols
• Knowledge of medical terminology and appropriate abbreviations
• Ability to read and comprehend short correspondence, and memos
• Ability to document, with clarity, all information relevant to a patient’s needs
• Ability to effectively present information in small group situations to patients, Clinic staff, and the general public. 
• Ability to work cooperatively with community agency personnel to coordinate services for patients
• Ability to use office equipment including but not limited to computers, fax machines, telephones and copiers
• Ability to prioritize and allocate resources

Preferred

• Spanish speaking and writing skills

Education and Experience

Required

• High School Diploma

Preferred

• One (1) year of practice experience in a clinic office setting.

• Licensed Vocational Nurse (LVN) or Certified Medical Assistant

Special Requirements

The employee must be able to lift and/or move more than 50 pounds. Requires full range of body motion including handling and lifting patients, manual and finger dexterity and eye/hand coordination.  Requires sitting, standing and walking for extensive periods of time.   Requires working under stressful conditions or working irregular hours.  Requires frequent exposure to communicable diseases, body fluids, toxic substances, medicinal preparations and other conditions common to a clinic environment. The employee frequently is required to reach with hands and arms.   Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.  Ability to work with a moderate noise level in the work environment is required.  Ability to handle significant stress.