Referral Specialist - CMHVI

Prime Healthcare • Lewiston, ME

34d

About The Position

Overview Central Maine Healthcare is an integrated healthcare delivery system serving 400,000 people living in central, western and Midcoastal Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center and other high-quality clinical services. Responsibilities The following statements are intended to describe the major elements and requirements of the position and should not be taken as an all-inclusive list of responsibilities, duties and skills required of an individual assigned to this job. Acts as a liaison between insurance, healthcare providers, and the clinic to ensure required referrals have been processed correctly for medical specialty visits. The Referral specialist is responsible for scheduling referrals for patients at the request of providers and/or staff. Directly communicates with the clinics, referred to clinics, and patients. Reviews clinical data to report medical necessity to insurance companies. Performs all work with accord to the mission, vision, and values of the practice. The referral specialist makes referrals to specialist for the office practices along with prior auth and creates positive relationships between the office practices and specialists. Other duties include, but are not limited to, filing/scanning patient reports, retrieving patient records for prior authorizations or medical records and completes insurance prior authorization. The Referral specialist should demonstrate adequate knowledge of the usual terminology of Referral process and tests/surgeries along with insurance plans. This person should demonstrate good telephone etiquette and be able to speak to patients and others in a polite and friendly manner. Be able to maneuvers through prior authorization with insurance companies and provide patient support by utilizing resources such as sliding fee scale, payment arrangements etc. Conveys a positive image of the organization and maintains a upbeat customer friendly attitude for internal and external Customers.

Requirements

• 2 year experience in a clinic work environment preferred.
• Knowledge of medical terminology preferred.
• Completion of medical assistant program desired Certified within 6 months of hire.
• Knowledge of Electronic Medical Systems.
• Excellent phone skills and customer service skills.
• Upbeat, positive, customer friendly attitude towards internal and external customers.
• Knowledge of prior authorizations and insurance plans.
• Good organization skills.
• Be able to act as a patient liaison to help them through navigate the healthcare system.
• Be a self-starter and able to multi-task.
• Able to organize and trouble shoot scheduling and or referral issues and have solutions.
• Detailed orientated.
• Be able to work in a changing environment.

Responsibilities

• Acts as a liaison between insurance, healthcare providers, and the clinic to ensure required referrals have been processed correctly for medical specialty visits.
• Responsible for scheduling referrals for patients at the request of providers and/or staff.
• Directly communicates with the clinics, referred to clinics, and patients.
• Reviews clinical data to report medical necessity to insurance companies.
• Makes referrals to specialist for the office practices along with prior auth and creates positive relationships between the office practices and specialists.
• Filing/scanning patient reports
• Retrieving patient records for prior authorizations or medical records and completes insurance prior authorization.
• Maneuvers through prior authorization with insurance companies and provide patient support by utilizing resources such as sliding fee scale, payment arrangements etc.
• Conveys a positive image of the organization and maintains a upbeat customer friendly attitude for internal and external Customers.

What This Job Offers

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