Referral Specialist - Full Time

UHS-posted 3 months ago
Full-time • Entry Level
Sarasota, FL
1,001-5,000 employees
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A Medical Referral Specialist manages the process of sending patients to other healthcare providers or specialists, acting as a liaison between patients, providers, and insurance companies. Key duties include verifying patient insurance, obtaining pre-approvals and authorizations, coordinating appointments, tracking referral statuses, and documenting all relevant information in the patient's record. This role requires excellent communication, organizational skills, and familiarity with medical insurance plans to ensure patients receive the care they need.

  • Confirming patient eligibility and benefits with insurance providers to ensure that specialty services are covered.
  • Initiating, tracking, and following up on referral requests to specialty providers.
  • Serving as a central point of contact for patients, referring providers, specialists, and insurance companies, managing communications between all parties.
  • Maintaining accurate and up-to-date records of all referral activities, including patient history, diagnosis, and consult reports.
  • Informing patients about referral requirements, appointment details, and the overall referral process.
  • Scheduling appointments with specialist providers and ensuring patients receive reminders.
  • Entering and updating patient information and medical records in the Electronic Health Record (EHR) system.
  • High school graduate or GED required.
  • Minimum of two years’ experience in a healthcare or clinical setting.
  • Knowledge of clinical terminology, insurance billing, procedural and diagnosis coding, federal and state insurance regulations and HIPAA privacy standards is strongly preferred.
  • Typing, 10 key and computer skills required.
  • Proficiency in Microsoft Office applications required.
  • Effective interpersonal skills and excellent written, oral communication skills required.
  • Acute healthcare knowledge and ability to evaluate clinical data to acquire pre-authorizations and referrals is preferred.
  • Knowledge of third-party reimbursement regulations is preferred.
  • Patient Management, Billing and Managed Care system processes competency.
  • Understanding of functions and workflow of Clinical/Hospital departments.
  • Excellent planning and organizational skills.
  • Demonstration of strong analytical skills and problem-solving abilities.
  • Strong teamwork skills and the ability to effectively communicate with all management levels.
  • Results oriented, independently goal directed, able to multi-task and meet established time frames.
  • Excellent customer service skills and must be able to work independently.
  • Strong Communication: Excellent verbal and written communication skills are crucial for interacting with patients, providers, and insurance staff.
  • Organizational Skills: The ability to manage multiple referrals, maintain records, and multitask in a fast-paced environment is essential.
  • Insurance Knowledge: Expertise in understanding various medical insurance plans and their authorization processes.
  • Computer Proficiency: Familiarity with computer systems, including electronic health records, is required.
  • Customer Service Focus: A patient-centric approach to provide support and address patient concerns effectively.
  • A Challenging and rewarding work environment
  • Competitive Compensation & Generous Paid Time Off
  • Excellent Medical, Dental, Vision and Prescription Drug Plans
  • 401(K) with company match
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