Clinic - Referral Specialist - CMME Oth Anc Svcs Neurology
About The Position
The Referral Specialist acts as a liaison among insurance companies, healthcare providers, clinics, and patients to ensure referrals for medical specialty visits are processed correctly. The role schedules referrals at the request of providers or staff, communicates with clinics and patients, reviews clinical data to support medical-necessity determinations, makes specialist referrals, and completes prior authorizations. It also supports positive working relationships between office practices and specialists. Additional duties include filing and scanning patient reports, retrieving patient records for prior authorizations or medical records, and helping patients navigate insurance and healthcare processes. The specialist should understand referral and procedure terminology and insurance plans, communicate politely by phone, and help patients access resources such as sliding-fee scales and payment arrangements. The role is expected to convey a positive image of the organization and maintain a friendly, customer-focused attitude.
Requirements
- Knowledge of electronic medical systems.
- Excellent phone and customer service skills.
- Knowledge of prior authorizations and insurance plans.
- Good organizational skills.
- Ability to act as a patient liaison and help patients navigate the healthcare system.
- Ability to work independently, self-start, and multitask.
- Ability to organize and troubleshoot scheduling or referral issues and identify solutions.
- Attention to detail.
- Ability to work in a changing environment.
- Upbeat, positive, customer-friendly attitude toward internal and external customers.
Nice To Haves
- Two years of experience in a clinic work environment.
- Knowledge of medical terminology.
- Completion of a medical assistant program; certification within six months of hire is desired.
Responsibilities
- Act as a liaison between insurance companies, healthcare providers, and clinics to ensure required referrals are processed correctly.
- Schedule referrals for patients at the request of providers or staff.
- Communicate directly with clinics, referred-to clinics, and patients.
- Review clinical data to report medical necessity to insurance companies.
- Make specialist referrals for office practices and complete prior authorizations.
- Build positive relationships between office practices and specialists.
- File and scan patient reports and retrieve patient records for prior authorizations or medical records.
- Support patients in navigating insurance and healthcare processes, including use of resources such as sliding-fee scales and payment arrangements.
- Maintain polite telephone etiquette and a positive, customer-friendly attitude toward internal and external customers.
- Perform work in accordance with the practice's mission, vision, and values.
Benefits
- A comprehensive, competitive benefits package with options that staff can customize to fit their needs.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
