Referral Specialist - Full Time

UHS•Bradenton, FL

2d•Onsite

About The Position

The Referral Specialist is responsible for scheduling referrals for patients and providers, as well as pre-authorizing and pre-certifying tests/procedures. This role involves scheduling other tests with facilities at the request of providers and/or staff. The specialist will communicate effectively with patients, clinics, and hospitals, and review clinical data to report medical necessity to insurance companies. All work is performed in accordance with the mission, vision, and values of the practice. Independence Physician Management (IPM), a subsidiary of UHS, develops and manages multi-specialty physician networks and urgent care clinics. IPM operates in 11 markets across six states and the District of Columbia, dedicated to improving community health and wellness.

Requirements

High school graduate or GED required
Minimum of one-three years’ experience in a healthcare or clinical setting
Knowledge of clinical terminology, insurance billing, procedural and diagnosis coding, federal and state insurance
Typing, 10 key, and computer skills required
Proficiency in Microsoft Office applications required
Patient Management, Billing and Managed Care system processes competency
Understanding of functions and workflow of Clinical/Hospital departments
Excellent organization skills, attention to detail, research, and problem-solving ability
Results oriented with a proven track record of accomplishing tasks within a high-performing team environment
Able to multi-task and meet established time frames
Required effective interpersonal skills and excellent written, oral communication skills required
Service-oriented/customer-centric
Strong teamwork skills
Strong computer literacy skills including proficiency in Microsoft Office
Ability to handle data entry accurately in a high-paced environment
Ability to reconcile data and identify discrepancies

Nice To Haves

Knowledge of regulations and HIPAA privacy standards is strongly preferred
Acute healthcare knowledge and ability to evaluate clinical data to acquire pre-authorizations and referrals is preferred
Knowledge of third-party reimbursement regulations is preferred

Responsibilities

Scheduling referrals for patients and providers
Pre-authorizing and pre-certifying tests/procedures
Scheduling of other tests with facilities at the request of providers and/or staff
Communicating effectively with patients, clinics, and hospitals
Reviewing clinical data to report medical necessity to insurance companies
Performing all work with accord to the mission, vision, and values of the practice