Referral Specialist - EngageMED

EngageMED Inc • North Little Rock, AR

4d

About The Position

The Referral Specialist works with patients requiring a referral, to ensure patients referral needs are fulfilled for specialty service office visits. Processes referrals, authorizations and pre-certifications for patients, to ensure timely reimbursement.

Requirements

• Knowledge of clinic referral and scheduling processes and billing/authorization requirements.
• Knowledge of federal and state pay requirements, including Medicare, DSHS, HMO/PPO Contracts.
• Ability to communicate effectively and to maintain strict confidentiality.
• Ability to respond to people and issues promptly and appropriately, to resolve problems.
• A team player who handles multiple projects simultaneously in a fast paced environment.
• Possess a strong work ethic and a high level of professionalism.
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
• Ability to write reports, business correspondence, and procedure manuals.
• Ability to effectively present information and respond to common inquiries or complaints from groups of managers, clients, customers, and the general public.
• Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals.
• Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Must be proficient with the Microsoft Office Suite, Internet navigation, database management, desktop publishing, spreadsheet, and graphic presentation packages.

Responsibilities

• Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.
• Communicate detailed information and answers patients' questions regarding their health care plan; provide answers to billing and insurance clarification questions.
• Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc.
• Coordinate flow of information between medical clinic and referral authorization department to secure a valid referral for clinic patient.
• Enter referrals, documents communications and action into the system, as appropriate.
• Notify physician(s) and patient when referral is denied, or if additional information is needed.
• Develop and maintain database of referral physician offices preferred by each physician within the clinic.
• Assist Practice Manager with complaint resolution and solutions related to patient referrals.
• Perform other duties as assigned by the practice manager or physician.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed