Referral Specialist - Orthopedics

Prime Healthcare•Auburn, ME

6d•Onsite

About The Position

The Referral Specialist in Orthopedics acts as a crucial liaison between insurance companies, healthcare providers, and the clinic. This role ensures that all necessary referrals for medical specialty visits are processed correctly. The specialist is responsible for scheduling these referrals at the request of providers and staff, directly communicating with clinics, referred-to clinics, and patients. A key part of the role involves reviewing clinical data to articulate medical necessity to insurance companies. The Referral Specialist also handles prior authorizations, files/scans patient reports, retrieves patient records, and assists patients with resources like sliding fee scales and payment arrangements. The position requires a strong understanding of medical terminology, referral processes, insurance plans, and electronic medical systems, along with excellent customer service and organizational skills. The individual must maintain a positive, customer-friendly attitude and be able to navigate the healthcare system effectively to support patients.

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.
Ability to act as a patient liaison to help them navigate the healthcare system.
Ability to be a self-starter and able to multi-task.
Ability to organize and trouble shoot scheduling and/or referral issues and have solutions.
Detailed oriented.
Ability 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.
Makes referrals to specialists for the office practices along with prior authorizations.
Creates positive relationships between the office practices and specialists.
Files/scans patient reports.
Retrieves patient records for prior authorizations or medical records.
Completes insurance prior authorizations.
Demonstrates adequate knowledge of the usual terminology of the referral process and tests/surgeries along with insurance plans.
Demonstrates good telephone etiquette and the ability 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 an upbeat customer friendly attitude for internal and external customers.