Referral Specialist - Ambulatory Patient Access - FT Days

Sky Lakes Medical Center•Klamath Falls, OR

About The Position

The Referral Specialist supports ambulatory patient access by prioritizing and processing referrals, ensuring servicing providers receive complete demographic, insurance, and relevant clinical information, and working with insurance companies to meet prior authorization requirements. The role presents medical information to insurers to establish medical necessity and researches out-of-area specialists when needed. The employee is expected to communicate professionally, protect confidential information, use relevant office and job-related software effectively, stay current with developments and technology, and demonstrate competence with the organization’s mission, vision, values, and strategic plan. The position requires reliable attendance, efficient time management, minimal supervision, and the ability to work additional hours when necessary to reach goals. The work involves sitting or standing, walking, reaching, occasionally lifting or moving up to 10 pounds, and viewing a computer monitor throughout the shift. The employee must be able to focus amid open-office distractions and competing priorities. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requirements

Ability to perform the essential job functions satisfactorily, with reasonable accommodations when applicable.
Clear thinking and ability to focus on work tasks amid open-office distractions and competing priorities.
Professional communication skills, including speaking clearly, listening, seeking clarification, responding to questions and feedback, and keeping others informed.
Ability to maintain confidentiality in accordance with policy and regulations.
Fluency in Word, Excel, Outlook, job-related software, and computers.
Ability to adapt to new technologies and keep technical skills current.
Ability to sit or stand, walk, and reach; occasionally lift or move up to 10 pounds; and view a computer monitor throughout the shift.

Responsibilities

Prioritize referrals by urgency and address them in a timely manner.
Use time efficiently and maintain consistent attendance and punctuality.
Ensure complete demographic, insurance, and relevant clinical information is sent to referred servicing providers.
Contact insurance companies to ensure prior authorization requirements are met.
Present necessary medical information to insurance companies to support medical necessity.
Research and locate out-of-area specialists as needed for referrals.
Work additional hours when necessary to reach goals.
Communicate clearly and professionally, listen and seek clarification, respond to questions and feedback, participate in meetings, edit work for spelling and grammar, keep others informed, and use appropriate communication methods.
Keep abreast of current developments, require minimal supervision, understand how the job relates to others, and maintain confidentiality according to policy and regulations.
Use Word, Excel, Outlook, job-related software, computers, and available resources effectively; adapt to new technologies and keep technical skills current.
Demonstrate competence in the organization’s mission, vision, values, and strategic plan through applicable proficiency testing, skill demonstration, core service standards, and documentation review.
Perform other duties as assigned.