Referral Specialist Trauma
About The Position
The Referral Specialist will provide direct support to patients by coordinating referrals for women's health services. This role is crucial in ensuring patients receive continued treatment, such as specialty services and diagnostic testing, within a primary care practice. The position involves gathering and providing all necessary clinical information for payor authorization and facilities/specialists before services are rendered. Additionally, the Referral Specialist will track and manage all referrals to close patient care gaps and provide documentation to enhance team awareness. The schedule for this position is Monday-Friday, 8:00 am to 4:30 pm.
Requirements
- High school diploma/GED or equivalent working knowledge.
- 1 year of direct patient interaction/experience in a medical, insurance, or healthcare related industry.
- Knowledge of HIPAA regulations.
- Strong customer service focus and willingness to problem solve.
- Effective verbal and written communication skills.
- Ability to manage competing priorities.
- Proficient with commonly used office software.
Nice To Haves
- Previous knowledge of managed care concepts.
- Working knowledge of medical terminology and ICD-9 and CPT codes.
- Additional related education and/or experience.
Responsibilities
- Schedules appointments for specialty physician services and diagnostic testing per provider request and communicates with the patient on a timely basis for all scheduling requirements.
- Acts as a liaison between patients, providers, and staff members for patients’ referral and follow up needs, providing prompt and professional service by educating patient/family and assisting patients with external resources when needed.
- Provides all pertinent clinical information needed for the payor authorization, the facility or specialist prior to the services being rendered by verifying coverage, obtaining authorization, and communicating with receiving facilities.
- Tracks and manages all referrals by monitoring outstanding referrals at 30/60/90 day intervals and following up with patients if appointments are not kept.
- Applies knowledge of medical terminology and maintains up-to-date knowledge of the insurance environment, utilizing internal and external resources to seek knowledge about regulations regarding various payor sources.
- Collaborates with outside referral sources and other community resources, maintaining an updated list of community resources and networking with colleagues to develop additional referral sources.
- Communicates frequently with patients, physicians, staff, and third-party payers.
- Works with and understands the concepts of managed health care.
- Prioritizes tasks within established guidelines with moderate supervision.
Benefits
- Comprehensive benefit package for all benefit-eligible positions.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
