Referral Specialist - Georgetown Clinic (1.0 FTE)

Neighborcare Health Career•Seattle, WA

About The Position

The Referral Specialist receives, analyzes, and processes patient referrals and authorization requests according to insurance requirements. The role ensures patients are cleared for specialty visits and certain procedures, and supports clinical staff with the administrative aspects of referrals. The Specialist works with the Coding Team to ensure referral billing codes are accurate and with the Insurance Verification Team to verify insurance before referrals or prior authorizations are submitted. The position also coordinates patient care with specialists, verifies insurance and benefits, and obtains prior authorizations.

Requirements

Associate’s degree or equivalent from a two-year college or technical school.
Two years of experience in a medical setting, or an equivalent combination of education and experience.
Working knowledge of electronic health record systems.
Knowledge of ICD-10 and CPT coding, medical terminology, and billing rules for government and third-party payers.
Ability to work effectively with a team and with patients, and to collaborate with healthcare professionals at all levels.
Ability to use personal computers and learn company software, including practice management systems, spreadsheets, and word processing applications.
Skill in time management and proficiency in data entry.
Ability to understand the clinical content of a health record.
Effective written and oral communication skills, including the ability to present, explain, and write information clearly, concisely, and in an organized format.

Responsibilities

Process physician referral orders, including EKG, EMG, CT, and MRI orders, in the EHR system and obtain required authorizations in a timely manner.
Enter notes in the EHR about insurance correspondence, authorization decisions, and other referral notifications.
Communicate authorization request results to patients.
Answer incoming calls from patients and insurance companies.
Maintain current knowledge of insurance plans and billing rules.
Perform other duties as assigned within job qualifications.