Referral Specialist

Intermountain Health•Nevada Central Office, NV

2d•$19 - $28•Onsite

About The Position

The Referral Specialist is the first connection between Intermountain and patients, fostering collaborative relationships with patients, parents, guardians, and fellow caregivers to deliver high levels of customer and patient satisfaction. The role supports patient care by ensuring compliance with managed care, commercial insurance, and public insurance requirements; submitting and tracking referrals; and promoting efficient patient flow and service excellence. The specialist responds to patient, provider, and staff requests, which may include referral processing, scheduling and registration, business, billing, and payer inquiries, and medical requests. The role verifies eligibility and benefits, obtains authorizations, tracks referrals, documents authorization and referral details, and coordinates with patients, providers, clinics, insurers, and other teams. It also gathers information about patients' financial obligations, sends pertinent medical records and authorization information to provider offices, and follows a three-touch outreach process using MyChart, phone, and letter.

Requirements

Demonstrated experience using multiple business software applications and insurance web portals simultaneously.
Prior experience in healthcare.

Nice To Haves

Associate degree or higher.
One year of experience with referral services, referral processing, authorization/referral claims administration, or a directly related field.

Responsibilities

Identify and resolve patient, provider, and staff requests related to referrals, scheduling and registration, billing and payer inquiries, and medical matters.
Use analytical skills and technical resources to anticipate and resolve patient requests, apply critical thinking to challenging interactions, and follow procedures for medical and non-medical emergencies.
Support enterprise productivity and quality initiatives by participating in, planning, and communicating about performance measures and encouraging team and individual contributions toward Intermountain Health Key Performance Indicators.
Verify eligibility and benefits, obtain authorizations, and track referrals to ensure compliance with guidelines.
Coordinate insurance authorization requests for procedures and specialist visits between hospitals, physicians, health plans, vendors, patients, and other referral sources.
Gather information from insurance carriers, financial counselors, and ancillary staff to establish patients' financial obligations for services.
Document complete information in the referral shell, including authorization details and referral destination, and coordinate with teams, providers, staff, insurers, patients, and other clinics to close the loop.
Contact patients through MyChart, phone, and letter in accordance with the three-touch process.
Forward pertinent medical records and authorization information to the referred provider's office.