Referral Specialist

Banner Health

About The Position

The Referral Specialist coordinates referral orders for continuation of treatment, including specialty services and diagnostic testing, within a primary care practice. The role provides pertinent clinical information needed for payor authorization and to receiving facilities or specialists before services are rendered. It tracks and manages referrals to help close patient care gaps and documents referral activity to promote team awareness. The specialist schedules appointments, communicates scheduling requirements to patients, and serves as a liaison among patients, providers, and staff. The position also supports patient and family education, helps patients access external resources, verifies coverage, obtains authorizations, and follows up on outstanding referrals. The role works with patients, physicians, staff, third-party payers, referral sources, and community resources under moderate supervision. The position is based at Banner Churchill Community Hospital–Banner Health Clinic in Fallon, Nevada. The schedule is Monday through Friday, 7:00 a.m. to 3:30 p.m.

Requirements

High school diploma/GED or equivalent working knowledge.
One year of direct patient interaction or experience in a medical, insurance, or healthcare-related industry.
Knowledge of HIPAA regulations.
Strong customer service focus and willingness to problem solve.
Effective verbal and written communication skills.
Ability to manage competing priorities.
Proficiency with commonly used office software.

Nice To Haves

Previous knowledge of managed care concepts.
Working knowledge of medical terminology and ICD-9 and CPT codes.
Additional related education and/or experience.

Responsibilities

Schedule specialty physician appointments and diagnostic testing according to provider requests, and communicate scheduling requirements to patients promptly.
Serve as a liaison among patients, providers, and staff for referral and follow-up needs.
Provide prompt, professional patient service, including helping educate patients and families and assisting patients with external resources when needed.
Provide clinical information needed for payor authorization and receiving facilities or specialists before services are rendered.
Verify coverage, obtain authorizations, and communicate with receiving facilities.
Track and manage referrals, monitor outstanding referrals at 30-, 60-, and 90-day intervals, and follow up with patients who miss appointments.
Maintain knowledge of medical terminology and the insurance environment, using internal and external resources to learn about payor regulations.
Collaborate with outside referral sources and community resources, maintain an updated community resource list, and develop additional referral sources with colleagues.
Communicate frequently with patients, physicians, staff, and third-party payers, and prioritize tasks within established guidelines.