Referral Specialist

UnitedHealth Group•Acton, MA

15d•$16 - $29•Onsite

About The Position

Explore opportunities with Acton Medical Associates, part of the Optum family of businesses. Acton Medical Associates provides exceptional primary care for adult and pediatric patients. Our team of dedicated physicians and skilled professionals deliver personalized, top-notch support to every patient. With a focus on integrity and trust, we foster a care experience that brings confidence to patients and their families. Through our collaborative environment and commitment to clinical excellence, you’ll have the opportunity to make a meaningful impact while growing your career. Join a team at the forefront of value-based care and discover the meaning behind Caring. Connecting. Growing together. The Referral Specialist is responsible for obtaining insurance referral intake and processing the referral requests. In this role, the Referral Specialist speaks to patients on the phone, confirms patient demographic and insurance information makes appointments and obtains the proper information for referral requests. A key responsibility of the Call Center Representative is to ensure our patients received best possible customer service. This position requires excellent communication, computer and phone skills and the ability to multi-task.

Requirements

High School graduate or GED equivalent
Current Massachusetts nursing license
BCLS
Knowledge of EMR, scheduling and word processing software
Friendly and courteous personality
Excellent communication skills and the ability to maintain confidentiality

Responsibilities

Works full time, on site, to support the operations of the department and AMA-PC
Maintain a high level of professionalism and provide excellent patient servicing
Schedule future appointments following the individual provider’s protocol. Verify eligibility on all Mass Health members before scheduling the appointment
Follow phone queue daily assignment. Retrieve night and referral voicemail when assigned and follow-up on the messages
With the managers assistance, learns to problem solve and assist with the more complex referral requests
Follow-up with specialist offices to obtain pertinent information that is essential for the referral processing workflow
Enters referral requests in the Allscripts EMR from patient calls, Follow My Health or faxes received from physician offices
Obtain PCP approvals for insurances that require a physician signature and reviewer’s 2nd signature
Confirm specialist participation with insurance via the individual health plans website
Process referrals utilizing the correct web sites, and follow the 4-5 business day referral processing protocol
Must observe HIPAA & PHI (Protected Health Information) Regulations at all times
Other duties as assigned by Call Center Manager or Director