Referral Specialist - Cardiology

Prime Healthcare•Lewiston, ME

1d•Onsite

About The Position

Central Maine Healthcare (CMH) is seeking a Referral Specialist for their Cardiology department at Central Maine Medical Center (CMMC) in Lewiston, Maine. This full-time, day shift position involves acting as a liaison between insurance, healthcare providers, and the clinic to ensure proper processing of referrals for medical specialty visits. The role includes scheduling referrals, communicating with clinics and patients, reviewing clinical data for medical necessity, and creating positive relationships with specialists. Other duties involve filing, scanning, retrieving patient records, and completing insurance prior authorizations. The specialist will also assist patients with resources like sliding fee scales and payment arrangements, maintaining a positive and customer-friendly attitude.

Requirements

Knowledge of Electronic Medical Systems.
Excellent phone skills and customer service skills.
Upbeat, positive, customer friendly attitude towards internal and external customers.
Knowledge of prior authorizations and insurance plans.
Good organization skills.
Be able to act as a patient liaison to help them through navigate the healthcare system.
Be a self-starter and able to multi-task.
Able to organize and trouble shoot scheduling and or referral issues and have solutions.
Detailed orientated.
Be able to work in a changing environment.

Nice To Haves

2 year experience in a clinic work environment preferred.
Knowledge of medical terminology preferred.
Completion of medical assistant program desired Certified within 6 months of hire.

Responsibilities

Acts as a liaison between insurance, healthcare providers, and the clinic to ensure required referrals have been processed correctly for medical specialty visits.
Schedules referrals for patients at the request of providers and/or staff.
Directly communicates with the clinics, referred to clinics, and patients.
Reviews clinical data to report medical necessity to insurance companies.
Performs all work with accord to the mission, vision, and values of the practice.
Makes referrals to specialist for the office practices along with prior auth and creates positive relationships between the office practices and specialists.
Filing/scanning patient reports.
Retrieving patient records for prior authorizations or medical records.
Completes insurance prior authorization.
Demonstrates adequate knowledge of the usual terminology of Referral process and tests/surgeries along with insurance plans.
Demonstrates good telephone etiquette and is able to speak to patients and others in a polite and friendly manner.
Maneuvers through prior authorization with insurance companies.
Provides patient support by utilizing resources such as sliding fee scale, payment arrangements etc.
Conveys a positive image of the organization and maintains a upbeat customer friendly attitude for internal and external Customers.