Referral Specialist-Full Time-Days
About The Position
The Referral Specialist is responsible for obtaining and/or verifying demographic, clinical, financial, and insurance information. This role validates the medical necessity of Medicare and Non-Medicare cases to ensure clinical and financial clearance. The specialist obtains and processes signed physician orders/referrals for accurate clinical documentation for care delivery and specialty/outpatient ancillary referrals. Additionally, the referral coordinator conducts online insurance eligibility/benefit verification, obtains pre-certification/authorization, referral clearance, and provides financial education on designated cases. As appropriate, the specialist notifies patients, specialists, and referring providers with pertinent information regarding clinical documentation and referral status.
Requirements
- High school diploma or equivalent required.
- Registered or Certified Medical Office Assistant OR 2 years of direct referral experience in lieu of certification required.
- 2 years insurance/referral experience within a hospital or medical office setting preferred.
- Knowledge of insurance and collection of payments.
- Experience with Microsoft software.
- Excellent verbal and written communication skills, customer service skills, and problem-solving abilities.
- Ability to appropriately handle complexity and stress with the changing needs of patients, families, visitors, and the Health System.
- May be required to periodically rotate shifts and regular days off.
- Flexibility to meet the department hours of operation.
- Ability to communicate orally, see, and hear to collect information.
- Dexterity to operate office equipment.
- Subject to eyestrain due to hours spent looking at monitor screen.
- Noise level is low to moderate.
- Answers telephone calls.
- Uses computer and other business machines extensively.
- Bends, reaches, pushes and pulls file drawers to file records and reports.
- Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds.
Nice To Haves
- Licensed Practical Nurse background preferred.
- Pass and maintain the Certified Healthcare Access Associate (CHAA) exam within one year of employment.
Responsibilities
- Maintains a working knowledge of medical administrative processes, including internal and external referrals, and obtaining/sending protected patient information.
- Performs insurance eligibility/benefit verification using various mechanisms and ensures authorization matches the referral.
- Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases for clinical and financial clearance.
- Obtains specialist contact information, prints orders, patient demographics, and provider letters, and documents appropriately in the EHR.
- Determines proper referral requirements and limitations, including identifying emergent referrals.
- Pre-registers patients for upcoming visits.
- Informs patients/guarantors of liabilities, including referral approval or denial, and documents appropriately.
- Sends and/or communicates appointment confirmations to referring offices and calls patients to remind them of appointment details and preparation.
- Completes follow-up protocols for routine and urgent referrals from initiation to completion.
- Assists insurance companies, physicians, physician practices, and hospital departments with patient information in accordance with HIPAA guidelines.
- Meets or exceeds accuracy standard goals determined by Patient Access Leadership.
- Performs other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
