Referral Specialist - Outpatient Imaging - Full-time

Sky Lakes Medical Center•Klamath Falls, OR

5d•Onsite

About The Position

The Referral Specialist is responsible for processing referral orders by obtaining necessary prior/retro authorizations and ensuring safe, successful transitions of care for patients. This role involves written and verbal communication with insurance agencies, medical entities, providers, patients, and peers. The specialist will maintain accurate and complete patient records with clear and comprehensive documentation, and utilize extensive knowledge of payor plans, diseases processes, radiology tests, and healthcare providers both locally and in surrounding communities.

Requirements

Ability to perform each essential job function satisfactorily.
Must be clear thinking and able to focus on work tasks amidst open office distractions and competing priorities.
Must be consistently at work and on time, as established.
Must use time efficiently.
Must keep abreast of current developments.
Requires minimal supervision.
Must display understanding of how job relates to others.
Must maintain confidentiality per policy and regulations.
Fluent in Word, Excel, and Outlook as well as job-related software and computers.
Must use available resources effectively.
Must adapt to new technologies.
Must keep technical skills up to date.
Demonstrates competence in relation to the defined mission, vision, values, and strategic plan of the organization.
Proficiency testing, skill demonstration, practice of core standards for service excellence, and documentation review.

Nice To Haves

Knowledge of healthcare providers both locally and in surrounding communities.

Responsibilities

Processing referral orders by obtaining necessary prior/retro authorizations.
Ensuring safe, successful transitions of care for patients.
Communicating in writing and verbally with insurance agencies, medical entities, providers, patients, and peers.
Maintaining accurate and complete patient records with clear and comprehensive documentation.
Utilizing extensive knowledge of payor plans, diseases processes, radiology tests, and healthcare providers.
Prioritizing referrals by urgency and addressing them in a timely manner.
Ensuring complete demographic, insurance information and appropriate/pertaining clinical information is sent to referred servicing providers.
Contacting insurance companies to ensure prior authorization requirements are met.
Presenting necessary medical information to insurance companies to prove the medical necessity of request.
Researching and locating out-of-area specialists as needed for referrals.
Scheduling patients to assist with workflows and work queues.
Performing other duties as assigned.