Referral Specialist, Hybrid - Northampton

Massachusetts General Hospital - Northampton, MA

Full-time - Entry Level

Hybrid - Northampton, MA

Hospitals

About the position

The Referral Specialist at Cooley Dickinson Medical Group plays a crucial role in ensuring that third-party payer referral requirements are met. This full-time position involves processing specialty referral orders, coordinating specialty care for patients, and verifying insurance benefits. The role is hybrid, allowing for a mix of on-site and remote work after an initial training period.

Responsibilities

• Receive and process specialty referral orders from providers or patients using the electronic health record.
• Ensure timely coordination of specialty care for patients.
• Verify insurance policy benefit information and obtain authorization/pre-certification prior to the patient's visit or scheduled admission.
• Provide patient and referral information to patients, third party payers, specialists, and other health care providers.
• Assist providers in obtaining necessary information, including diagnosis codes, procedure codes, and pricing information.
• Document all referral processing steps and patient interactions using the electronic health record system.
• Follow up on pending referrals and obtain progress notes from specialists.
• Maintain established organizational and departmental policies and procedures, objectives, and compliance standards.
• Engage in professional growth through attendance at seminars, workshops, and conferences.
• Meet annual competency and retraining requirements.

Requirements

• High school diploma or equivalent required.
• One (1) to three (3) years of medical insurance experience.
• Demonstrated knowledge of medical terminology required.

Benefits

• Opportunities for growth and development
• Flexible work schedule after training
• Hybrid work environment after initial onboarding