Patient Referral Specialist - Neurology (Midland)

MyMichigan Health • Midland, MI

2d

About The Position

The Patient Referral Specialist coordinates the timely completion, monitoring, and submission of incoming and outgoing third-party payer referrals for primary care departments. The role works closely with providers, insurers, patients, office staff, and outside sources to obtain, resolve, document, and communicate referral pre-authorizations for specialist services and diagnostic testing. The specialist serves as a liaison with third-party and managed-care insurers to stay current on changes to referral pre-authorization procedures and maintains incoming and outgoing referral databases in Electronic Health Record systems.

The position also tracks referrals, prepares occasional monthly referral-utilization reports for management, and investigates disputed or incomplete requests, including authorizations and follow-up on specialty appointments. The work involves frequent public contact, communication by phone and in person, decision-making, and exposure to stressful situations.

Employees are expected to demonstrate competency in Microsoft Windows and may be required to participate in additional learning opportunities offered by MyMichigan Health. The role has a Light physical demand level and includes regular periods of sitting, standing, or walking, possible postural changes, and occasional lifting or carrying of 11–20 pounds.

Requirements

• High school diploma or GED.
• Two to four years of medical office experience.
• Excellent interpersonal and customer relations skills.
• Advanced medical terminology knowledge.
• ICD-9/ICD-10 and CPT coding experience within a physician practice.
• Knowledge of third-party payer rules.
• Medical record charting and documentation experience.
• Established written and verbal communication skills.
• Good organization and prioritization skills.
• Proficient computer user; experience with Windows, word processing, and medical practice software.
• Ability to work independently.
• Ability to handle multiple tasks and stressful situations.
• Ability to communicate verbally in person and by phone, and in writing.
• Ability to maintain regular and predictable attendance and stay awake.
• Ability to move freely about the facility with or without an assistive device and perform the job functions described.
• Overall vision and hearing, with or without assistive devices.
• Dexterity for handling, reaching, grasping, fingering, and feeling, potentially repeated regularly or frequently.
• Ability to wear personal protective equipment, including latex materials or an appropriate substitute if required.
• Follow required bloodborne pathogen and TB testing procedures.
• Ability to occasionally lift or carry 11–20 pounds and frequently handle 10 pounds and/or walk, stand, or push/pull arm or leg controls.

Nice To Haves

• Associate's degree preferred.
• Experience as a Medic computer user.
• Database application knowledge and skills.

Responsibilities

• Work with providers, office staff, and outside sources to complete third-party referral authorization forms accurately and promptly, transmitting them by mail, fax, telephone, or electronically.
• Enter and track incoming and outgoing referrals using Electronic Health Record systems.
• Compile monthly statistical reports on referral utilization for management reporting purposes.
• Investigate and respond to disputed or incomplete referral requests, including authorizations and follow-up on specialty appointments.
• Maintain incoming and outgoing referral databases.
• Communicate and coordinate with providers, insurers, and patients regarding referral pre-authorizations.
• Stay informed about changes and developments in third-party and managed-care insurer referral pre-authorization procedures.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED