Referral Specialist

PURPOSE OF POSITION

To assure that all referrals are managed effectively and efficiently including prior authorizations.

RESPONSIBILITIES & EXPECTATIONS

Referral Management

Work with the provider, clinical care team and patient to coordinate and oversee the management of all patient referrals for diagnostic and specialty services. This would include the following:

• Responsible for total coordination and processing of all patient referrals for diagnostic testing and specialty services
• Follows protocols for proper pre-authorization for all referral per insurance plan requirements. Present additional medical information to review organization/insurance as necessary to obtain pre-authorization
• Enters all referral authorizations into the computer system
• Maintain tracking of referral reports not received and timely follow-up in accordance with the office policy and procedures
• Maintain tracking of patients referred but not following through with a referral appointment and documenting patient response or lack of

Referral Coordination

• Ensure that referrals are addressed in a timely manner and reviews details and expectations about the referral appointment with the patients.
• Schedule patient as per provider referral order for diagnostic testing, therapy or specialist appointment at network facilities or specialty office
• For specialist referrals, assemble pertinent office notes, labs, testing, etc and fax to specialist office and give patient referral letter with specialist name, location with directions if necessary, date and time of appointment
• For diagnostic testing patient will be advised of date, time and necessary test preparations. Check chart for test orders and make sure it has been faxed to the appropriate facility. If order is not present in chart, send note to provider to order the test in the chart and fax to appropriate facility
• A patient note containing referral information is sent to the primary referral coordinator for necessary insurance pre-authorizations and saved to chart when process is completed.
• Other duties as assigned by Lead/Manager

Job Requirements

• Minimum of one (1) year medical experience in physician’s office
• Knowledge of medical terminology
• Knowledge of ICD-10 and CPT codes for the purpose of authorizations
• Knowledge of insurance plans and their rules

Skills

• Excellent customer service skills
• Effective verbal, written and listening communication skills
• Ability to work independently, self-motivated, and prioritize.
• Ability to establish and maintain effective working relationships with patients, medical staff, and co-workers
• Ability to work with a diverse patient, physician and coworker population
• Proficient computer skills – data entry, retrieval and report generation.

Job Type: Full-time

Pay: $16.00 - $19.23 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Application Question(s):

• Who, if anyone, referred you to this position?

Education:

• High school or equivalent (Required)

Experience:

• Referral Specialist: 1 year (Preferred)
• EHR systems: 1 year (Preferred)
• Medical terminology: 1 year (Preferred)
• Physician's Office: 1 year (Preferred)

Work Location: In person

Salary : $16 - $19