Referral Specialist

Sunset Health•Yuma, AZ

15h•Onsite

About The Position

The Referral Specialist handles incoming clinical tasks, phone calls, and in-person requests. This role involves reviewing clinical history, obtaining provider notes when necessary, and ensuring the correct payer, CPT, and ICD-10 codes are used on referral requisitions. All referrals must be processed in a timely and efficient manner, adhering to referral policies and procedures. The specialist confirms insurance benefits and eligibility before processing referrals and ensures patients are assigned to a SH provider. This position also involves arranging appointments with external and internal specialties, faxing referral requisitions and pertinent information, and verbally notifying patients (or their parent/legal guardian) about appointment details, including date, time, location, special instructions, and any applicable out-of-pocket expenses. A key responsibility is following up on referrals pending prior authorization or appointment at least weekly, documenting all efforts in the EHR. The role requires good time-management skills to contribute to increased productivity, active participation in staff meetings, and collaboration with team members to achieve department goals. The Referral Specialist will report weekly statistics of all referrals processed to the Practice Manager and utilize multiple software systems for insurance verifications and referral processing. Demonstrating an understanding of organizational structure by using appropriate communication channels for departmental activities is essential. The role also includes using computers, fax/copy machines for clinic business, maintaining clean and organized work areas, and adhering to HIPAA confidential practices and all Sunset Health policies and procedures. Other duties as assigned.

Requirements

Experience with insurance verifications.
Experience with referral processing.
Proficiency in using multiple software systems.
Understanding of organizational structure and appropriate communication channels.
Ability to use computers, fax/copy machines.
Ability to keep work areas clean and organized.
Adherence to HIPAA confidential practices.
Adherence to all Sunset Health policies and procedures.

Nice To Haves

Experience obtaining provider notes.
Knowledge of CPT and ICD-10 codes.

Responsibilities

Handle incoming clinical tasks, phone calls, and in-person requests.
Review clinical history and obtain notes for provider when needed.
Ensure correct payer, CPT, and ICD-10 codes are on referral requisition.
Process all referrals in a timely and efficient manner according to policies and procedures.
Confirm insurance benefit and eligibility prior to processing the referral.
Ensure patient is assigned to a SH provider.
Arrange appointments with external and internal specialties.
Fax referral requisition and any pertinent information.
Notify patients, or parent/legal guardian, verbally regarding appointment date, time, location, special instructions, and out-of-pocket expenses.
Follow up on referrals pending prior authorization/appointment at least weekly, documenting all efforts in EHR.
Use good time-management skills to contribute to increased productivity.
Actively participate in staff meetings and work toward accomplishing department goals and objectives.
Work well with team members.
Report statistics of all referrals processed weekly to the Practice Manager.
Use multiple software systems for insurance verifications and referral processing.
Demonstrate an understanding of organizational structure by utilizing appropriate channels of communication.
Use computers, fax/copy machines for clinic business.
Keep work areas clean and organized.
Adhere to HIPAA confidential practices for patient information.
Adhere to all Sunset Health policies and procedures.
Perform other duties as assigned.