REFERRAL SPECIALIST

UHS • Enid, OK

7d

About The Position

St. Mary’s Physician Associates is a multi-specialty group of employed physicians and midlevel providers serving a ten-county area in northwestern Oklahoma. The Referral Specialist schedules patient referrals and other tests requested by St. Mary’s Physician Associates providers or staff, and obtains pre-authorizations and pre-certifications for tests and procedures. The role communicates directly with SMPA clinics, referred-to clinics, and patients, and reviews clinical data to report medical necessity to insurance companies. All work is performed in accordance with the mission, vision, and values of St. Mary’s Physician Associates, LLC.

Requirements

• High school graduate or GED.
• At least two years of experience in a healthcare or clinical setting.
• Typing, 10-key, and computer skills.
• Proficiency in Microsoft Office applications.
• Effective interpersonal skills and excellent written and oral communication skills.
• Patient Management, Billing, and Managed Care system process competency.
• Understanding of the functions and workflows of clinical and hospital departments.
• Excellent planning and organizational skills, strong analytical and problem-solving abilities, and strong teamwork skills.
• Ability to communicate effectively with all management levels.
• Results-oriented and independently goal-directed, with the ability to multitask and meet established time frames.
• Excellent customer service skills and ability to work independently.

Nice To Haves

• Knowledge of clinical terminology, insurance billing, procedural and diagnosis coding, federal and state insurance regulations, and HIPAA privacy standards.
• Acute healthcare knowledge and ability to evaluate clinical data to obtain pre-authorizations and referrals.
• Knowledge of third-party reimbursement regulations.

Responsibilities

• Schedule referrals for patients of St. Mary’s Physician Associates providers.
• Obtain pre-authorizations and pre-certifications for tests and procedures.
• Schedule other tests with facilities at the request of SMPA providers or staff.
• Communicate directly with SMPA clinics, referred-to clinics, and patients.
• Review clinical data and report medical necessity to insurance companies.
• Perform work in accordance with the mission, vision, and values of St. Mary’s Physician Associates, LLC.

Benefits

• Competitive compensation.
• Generous paid time off.
• Medical, dental, vision, and prescription drug plans.
• 401(k) with company match.
• Challenging and rewarding work environment.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED