Referral Specialist I (US)

CareMore Health • Henderson, NV

1d

About The Position

The Referral Coordinator I processes routine referrals and supports authorization activities while meeting quality and productivity standards.

Requirements

• High school diploma or GED and minimum of 1 year of customer service or healthcare administrative experience required; or any combination of education and experience which would provide an equivalent background.
• Medical Assistant certificate / certification from an accredited training program required.
• Knowledge of medical terminology, plan specific guidelines; ICD-9 and CPT coding preferred.

Responsibilities

• Initiates and processes routing clinical referrals and authorization requests following established procedures.
• Serves as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources to support referral coordination.
• Reviews referrals for completeness and accuracy and follows up for additional information if necessary.
• Verifies insurance coverage and initiates pre-authorization requests in accordance with payer requirements and established workflows.
• Responds to inbound requests related to referral processing while meeting productivity and quality standards.
• Contacts physician offices as needed to obtain demographic information or related data.
• Enters referrals, documents communications, actions and related information in system.
• Escalates complex referral issues or authorization concerns to senior referral coordinators or leadership as appropriate.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 251-500 employees