NPID Referral Specialist

Oncology Consultants P A•Houston, TX

3d•Onsite

About The Position

The NPID Referral Specialist plays a crucial role in supporting patient care by managing and coordinating referrals for oncology and hematology services. This position ensures a seamless referral process by verifying insurance requirements and obtaining necessary referrals from Primary Care physicians and insurance carriers. This role is responsible for providing timely communication with patients, providers, and insurance carriers. The NPID Referral Specialist works closely with the verification team and Front Office teams to ensure that patients receive the care they need without unnecessary delay.

Requirements

High school diploma or equivalent.
Minimum of 2 years of experience in a healthcare setting, preferably in oncology, hematology, or a specialty practice.
Proficiency in insurance verification, prior authorizations, and EHR systems.
Strong knowledge of insurance policies, referral processes, and oncology treatment protocols.
Excellent communication, organizational, and multitasking skills.
Ability to maintain confidentiality and comply with HIPAA regulations
Able to type at least 35 WPM
Knowledge of business office procedures.
Working experience with health insurance.
Ability to operate a computer and basic office equipment.
Ability to operate a multi-line telephone system.
Skill in answering a telephone in a pleasant and helpful manner.
Ability to read, understand and follow oral and written instructions in English.
Ability to establish and maintain effective working relationships with patients, physicians, and fellow employees.

Responsibilities

Process incoming referrals for oncology and hematology services, ensuring accuracy and compliance with practice protocols.
Verify patient insurance coverage for referred services, ensuring referrals are directed to in-network providers.
Obtain prior authorizations for upcoming services provided in office (office visits, labs, and treatment).
Serve as the liaison between patients, referring providers, and external specialists or facilities.
Inform patients of referral details, including appointment dates, times, and any required preparation.
Maintain effective communication with clinical and front office staff to update referral and or change of insurance statuses.
Ensure all referral documentation is complete and meets insurance and regulatory requirements.
Track and follow up on referral statuses, maintaining detailed records in the electronic health record (EHR) system.
Maintain knowledge of insurance guidelines, authorization requirements, and oncology-specific care protocols.
Provide patients with guidance on their insurance coverage and any potential financial responsibilities related to referrals.
Address patient questions and resolve issues related to the referral process promptly and professionally.
Communicate with patients and fellow employees Via Company Email clearly and timely
Interact professionally with patients, physicians, and fellow employees
Cooperate with team members to accomplish departmental goals
Accept and incorporate changes or new ideas into daily work.
Provide service in a timely and accurate manner to both patients and fellow employees.
Understand and adhere to policies and procedures
Recognize priorities and take action; make productive use of time
Strive to resolve problems and conflicts in order to maintain patient care flow
Any other activity as directed by the doctor, supervisor or administrator