Referral Specialist

Glbhc•Saginaw, MI

14d•Hybrid

About The Position

The Referral Specialist is responsible for handling incoming departmental calls, processing insurance authorizations, communicating with patients about appointments and tests, tracking pended requests, and documenting all referral activities in the EHR. This role ensures smooth transitions of care and adherence to established protocols. The position requires excellent customer service skills and the ability to manage priorities effectively, including STAT and Urgent orders.

Requirements

High school diploma.
Completion of a Medical Assistant program preferred.
Registered MA or certification preferred.
In lieu of medical training, five years or more experience considered.
Education in a healthcare related field required.
Minimum of three (3) years of experience in a medical setting.
Excellent telephone etiquette.
Clerical skills such as filing and completion of forms.
Legible handwriting.
Ability to operate office equipment including computer, fax machine, copy machine, etc.
Able to follow through with assignments in a timely manner.
Must be able to use Microsoft Office and other applications as necessary.
Ensures that patient confidentiality is maintained at all times.
Able to communicate effectively with, and relate to, diverse population.
Must be able to define problems, collect data, establish facts, draw conclusions to resolve issues/problems that occur during the referral process.
Ability to follow oral and/or written instructions.
Able to work independently and/or as a team member.
Must exhibit excellent customer service skills daily.

Nice To Haves

Completion of a Medical Assistant program preferred.
Registered MA or certification preferred.

Responsibilities

Answers incoming departmental calls, ensuring that all calls are handled or routed as appropriate.
Processes insurance company authorization per the preferred method (electronic, fax, telephone) for any referral requiring prior authorization.
Notifies specialist office or testing facility of prior auth approval/auth number if required.
Ensures that all authorizations are communicated to entities applicable in the process, and that relevant documentation is shared according to established practices within GLBHC guidelines.
Communicates with patients regarding scheduled appointments and/or tests using the appropriate method of communication based upon timing of appointments, as established in departmental protocol.
Follows established tracking guidelines on pended requests for specialist, testing appointments and prior authorization results.
Documents all activity related to referral/test order in the EHR; documents the appointment date and time.
Completes Transition of Care (TOC) activities, documents the transmission of TOC with every referral completed.
Provide reminder calls to patients of up-coming referral appointments.
Assist with data collection as designated by manager.
Perform other duties as assigned.
Give priority to STAT orders, Urgent orders, daily testing, then normal orders for the assigned sites, in that order, on a daily basis.