Referral Specialist

Prime Healthcare Illinois Medical Group•Joliet, IL

7d•$17 - $24•Onsite

About The Position

The Referral Specialist acts as a liaison between insurance companies, healthcare providers, and the clinic to ensure referrals for medical specialty visits are processed correctly. The role schedules referrals at providers’ or staff members’ request and communicates directly with clinics, referred-to clinics, and patients. It reviews clinical data to report medical necessity to insurers, completes insurance prior authorizations, and builds positive relationships between office practices and specialists. The specialist also files and scans patient reports and retrieves patient or medical records for prior authorizations and other needs. The role requires familiarity with referral processes, tests and surgeries, and insurance plans, as well as courteous telephone communication and patient support, including assistance with resources such as sliding fee scales and payment arrangements. The Referral Specialist performs work in accordance with the practice’s mission, vision, and values and maintains a positive, customer-friendly image for internal and external customers.

Requirements

Excellent telephone and customer service skills.
Knowledge of electronic medical systems.
Knowledge of prior authorizations and insurance plans.
Good organizational skills and attention to detail.
Ability to act as a patient liaison and help patients navigate the healthcare system.
Ability to self-start and multitask.
Ability to organize and troubleshoot scheduling or referral issues and identify solutions.
Ability to work in a changing environment.
A positive, customer-friendly attitude toward internal and external customers.

Nice To Haves

Two years of experience in a clinic work environment preferred.
Knowledge of medical terminology preferred.
Completion of a medical assistant program desired; certification is required within six months of hire.

Responsibilities

Act as a liaison between insurance companies, healthcare providers, and the clinic to ensure required referrals are processed correctly.
Schedule referrals for patients at the request of providers or staff.
Communicate with clinics, referred-to clinics, and patients.
Review clinical data and report medical necessity to insurance companies.
Make specialist referrals for office practices and complete prior authorizations.
Build positive relationships between office practices and specialists.
File and scan patient reports and retrieve records for prior authorizations or medical-record needs.
Help patients navigate the healthcare system and provide support using resources such as sliding fee scales and payment arrangements.
Maintain a positive, polite, and customer-friendly attitude toward internal and external customers.
Perform work in accordance with the practice’s mission, vision, and values.