Patient Referral Specialist

HCA Healthcare•DALLAS, TX

3d•Remote

About The Position

The Patient Referral Specialist processes physician, hospital, and outpatient referrals and coordinates patient scheduling, insurance authorization, and guidance regarding insurance coverage. The role works with diagnostic and surgical service areas, physician offices, hospitals, and managed care representatives to ensure referrals and appointments are timely, accurate, and complete. It also involves documenting and tracking referrals, obtaining required orders and medical records, communicating appointment and preparation details, and ensuring the referral process is completed and closed. This is a full-time, work-from-home position with a Monday–Friday day schedule and no nights, on-call duties, weekends, or holidays.

Requirements

High school diploma or GED equivalent.
One year of experience in referral coordination relating to insurance provider tier levels, insurance authorizations, and out-of-network procedures.

Responsibilities

Process physician, hospital, and outpatient referrals.
Schedule patients and obtain insurance authorizations, or coordinate with the authorization coordinator to ensure required payer authorizations are received.
Work collaboratively with diagnostic and surgical service areas, physician offices, and hospitals to ensure appointments, tests, and procedures are scheduled accurately and on time.
Provide accurate patient demographic and medical information pertinent to scheduled appointments to support safety and quality care.
Determine insurance eligibility and authorization for medical office and surgical visits, including insurance provider tier levels and out-of-network procedures.
Initiate the EMR by entering patient demographics, referring and certifying physicians, and family information; obtain needed medical records from referring providers.
Establish rapport with physician offices, hospital personnel, and managed care representatives.
Use the EMR or other designated programs to capture and track referrals.
Obtain accurate and valid physician or advanced practitioner orders for appointments, tests, and procedures.
Communicate appointment, test, procedure, and preparation information accurately to patients and/or family members.
Adhere to privacy, compliance, and HIPAA regulations.
Ensure patients have follow-up physician appointments to discuss outcomes when appropriate.
Document appointment, test, scan, or procedure dates and times in the patient's medical record.
Communicate as appropriate with practice staff and ensure the referral process is completed and closed.
Submit outgoing referrals the same day, preferably while patients are present, to help obtain an optimal appointment.
Provide weekly reports to practice leadership on referral volume, referral status, and follow-up on outstanding appointments.
Perform related work and adhere to the Code of Conduct and Mission and Value Statements.

Benefits

Comprehensive medical, prescription drug, dental, vision, behavioral health, and telemedicine plans.
Wellbeing support, including free counseling and referral services.
Paid time off, paid family leave, long- and short-term disability coverage, and leaves of absence.
401(k) plan with a 100% match on 3% to 9% of pay, based on years of service.
Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support, and financial wellbeing counseling.
Tuition assistance, student loan assistance, certification support, dependent scholarships, and a partnership with Galen College of Nursing.
Fertility and family-building benefits and adoption assistance.
Life insurance and supplemental health protection plans.
Auto and home insurance, legal counseling, identity theft protection, and consumer discounts.
Work from home.