Referral Specialist, Pulmonology, FT, Days

Prisma Health•Richland, WA

About The Position

The Referral Specialist provides patients with a seamless entry into the Prisma Health experience. The role interfaces with patients and physician office team members to authorize consultations, procedures, and tests; uses each patient's preferred contact method; and transmits required clinical documentation to third-party payors and specialist physicians through electronic medical records. The specialist documents referral actions and encounters and follows up with patients, referring and referral physician practices, and payors, including on precertification, cancellations, rescheduling, and other events that may prevent referral completion. The position coordinates authorization and precertification with internal and external organizations and insurance companies, communicates relevant medical information, and provides information to financial services to support reimbursement. It records demographic, coverage, and scheduling information; reminds patients of appointments; keeps primary care charts updated with specialist scheduling information; and tracks referral status and follow-up until consultation, procedure, or test reports are received. Serving as a liaison among providers, practices, patients, and specialists, the Referral Specialist shares appropriate clinical information and referral needs, verifies physician orders, and explains guidelines, protocols, and locations to patients. The role helps patients address health-system navigation, financial, and social barriers, and responds to scheduling needs and questions to support a positive patient experience. It protects patient confidentiality and complies with HIPAA and Prisma Health compliance guidelines. Other duties may be assigned.

Requirements

High school diploma or equivalent preferred.
Two years of related work experience.
Customer service skills.
Communication skills.
Interpersonal skills.
Knowledge of various health insurance companies.
Knowledge of medical terminology, CPT and diagnosis coding, insurance verification and updates, and the authorization/precertification process.
Knowledge of Microsoft Office products.

Nice To Haves

Experience in a physician front office, including patient registration and/or electronic scheduling and the authorization/precertification process.
An associate degree or higher-level education may be considered in lieu of the stated education and/or experience.

Responsibilities

Coordinate authorization and precertification with internal and external organizations and insurance companies.
Present necessary medical information, such as patient history, diagnosis, and prognosis, and provide specific medical information to financial services to support reimbursement.
Record demographic, coverage, and scheduling information in applicable systems.
Remind patients of scheduled appointments by mail, internet, or telephone.
Keep the patient's primary care chart up to date with scheduling information for specialist consultations, tests, and procedures.
Alert management to trends in appointment availability and appointment-date timeliness.
Document referral status and appointments in the electronic medical record for referral tracking.
Follow up after consultations, procedures, and tests to confirm the physician received reports, and continue checking until complete.
Serve as a liaison among providers, practices, patients, and specialists, sharing appropriate clinical information and referral needs.
Verify physician orders and communicate guidelines, protocols, and locations to patients.
Help patients address health-care navigation, financial, and social barriers; request interpreters, transportation services, or prescription assistance when appropriate.
Advocate with insurance carriers when needed to obtain timely approval of necessary patient supplies or services.
Respond to patient scheduling requirements, questions, and concerns, and book timely appointments while explaining referral details and expectations.
Maintain patient confidentiality and comply with HIPAA and Prisma Health compliance guidelines.
Support effective facility operations and a positive patient, physician, and team-member experience.
Perform other duties as assigned.