Referral Specialist - Neurosurgical Care
About The Position
The Referral Specialist coordinates and manages the administrative requirements for referrals from primary care providers to specialists or specialty services, working directly with health plans. The role makes decisions and authorizes risk-planning referrals using departmental and organizational guidelines. It involves daily interaction with patients, staff, healthcare providers, and insurance companies. The position requires mastery of Patient Service Representative duties and responsibility for coordinating managed-care referral information, coding referrals, communicating contractual and system information, and keeping leaders and team members informed of changes to insurance requirements, providers, and guidelines.
Requirements
- Associate degree or equivalent combination of education and experience.
- Three years of experience in a healthcare insurance or related medical office setting.
- Working knowledge of ICD-10 and CPT codes.
- Ability to be flexible and relate well with others in a professional and pleasant manner.
- Knowledge of medical-record confidentiality.
- Excellent communication skills, with tact and poise when dealing with patients, physicians, and hospital staff.
Nice To Haves
- Medical terminology, medical billing, and computer skills.
- Working knowledge of insurance, Medicare, DSHS, Labor and Industries, and other third-party insurance.
Responsibilities
- Demonstrate mastery of all Patient Service Representative duties.
- Process patient referrals from primary care providers to specialists, working directly with health plans and troubleshooting when necessary.
- Coordinate information regarding managed-care referrals for patients, providers, case managers, and other Utilization Management staff.
- Assign appropriate ICD-10 and CPT codes to patient referrals.
- Communicate and disseminate key managed-care contractual information and system processes to patients and staff.
- Identify and communicate changes in insurance requirements, provider changes, and guidelines to leaders and team members.
- Perform other duties as assigned.
Benefits
- Medical, vision, and dental insurance.
- On-demand virtual health care.
- Health Savings Account.
- Flexible Spending Account.
- Life and disability insurance.
- Retirement plans (457(b) and 401(a) with employer contribution).
- Tuition assistance for undergraduate and graduate degrees.
- Federal Public Service Loan Forgiveness program.
- Paid Time Off/Vacation.
- Extended Illness Bank/Sick Leave.
- Paid holidays.
- Voluntary hospital indemnity insurance.
- Voluntary identity theft protection.
- Voluntary legal insurance.
- Pay in lieu of benefits premium program.
- Free parking.
- Commuter benefits.
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
